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General NPI Number Information
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NPI Number | 1306449384
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Entity Type | Organization
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Legal Business Name | THE CHANGE AGENCY
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Dates
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Enumeration Date | 11/20/2020
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 2400 W STROOP RD
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City | MORAINE
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State | OH
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Zip | 45439-2041
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Country | US
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Telephone | 937-315-0030
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Fax | 937-701-6901
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Provider Business Mailing Address
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Address Line | 2400 W STROOP RD
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City | MORAINE
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State | OH
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Zip | 45439-2041
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Country | US
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Telephone | 937-315-0030
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Fax | 937-701-6901
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Authorized Official
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Title or Position | DIRECTOR
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Name | JEORGE L LOGAN
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Credential | MSSA,LICDC,CPS-S
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Telephone | 937-303-6727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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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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