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General NPI Number Information
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NPI Number | 1306646559
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Entity Type | Organization
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Legal Business Name | CHANGE UP BEHAVIORAL SERVICES, LLC.
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 2408 ELECTRIC RD STE C
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City | ROANOKE
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State | VA
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Zip | 24018-3523
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Country | US
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Telephone | 336-986-4276
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Fax | 540-301-5821
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Provider Business Mailing Address
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Address Line | 626 WOODS AVE SW
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City | ROANOKE
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State | VA
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Zip | 24016-4828
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Country | US
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Telephone | 541-598-9512
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Fax | 540-301-5821
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Authorized Official
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Title or Position | CEO
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Name | CASEY MAURER
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Credential | BA
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Telephone | 540-598-9512
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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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