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General NPI Number Information
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NPI Number | 1275175861
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Entity Type | Organization
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Legal Business Name | A CHANGE IN LIFE LLC
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Dates
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Enumeration Date | 10/15/2019
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Last Update Date | 10/01/2021
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Provider Practice Location Address
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Address Line | 4901 FITZHUGH AVE STE 205
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City | RICHMOND
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State | VA
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Zip | 23230-3531
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Country | US
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Telephone | 804-716-5960
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Fax | 804-997-7907
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Provider Business Mailing Address
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Address Line | 4901 FITZHUGH AVE STE 205
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City | RICHMOND
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State | VA
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Zip | 23230-3531
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Country | US
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Telephone | 804-716-5960
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Fax | 804-997-7907
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Authorized Official
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Title or Position | OWNER/CEO
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Name | KEITH LAMONT SHELTON
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Credential |
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Telephone | 804-716-1560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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