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General NPI Number Information
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NPI Number | 1285244293
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Entity Type | Organization
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Legal Business Name | AGAPE CHANGE FAMILY COUNSELING & CONSULTATION SERVICES LLC
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Dates
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Enumeration Date | 08/04/2020
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Last Update Date | 08/04/2020
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Provider Practice Location Address
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Address Line | 2128 WILLAMETTE WAY
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City | DECATUR
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State | GA
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Zip | 30032-6036
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Country | US
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Telephone | 678-755-5585
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Fax |
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Provider Business Mailing Address
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Address Line | 2128 WILLAMETTE WAY
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City | DECATUR
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State | GA
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Zip | 30032-6036
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Country | US
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Telephone | 678-755-5585
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER/ POC
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Name | ANGELA BELCHER
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Credential |
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Telephone | 678-755-5585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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