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General NPI Number Information
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NPI Number | 1346629581
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Entity Type | Organization
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Legal Business Name | CENTER FOR CHANGE LLC
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 6325 N CENTER DR STE 202
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City | NORFOLK
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State | VA
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Zip | 23502-0019
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Country | US
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Telephone | 757-544-5020
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Fax | 757-227-3642
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Provider Business Mailing Address
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Address Line | 909 AUDUBON CIR
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City | CHESAPEAKE
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State | VA
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Zip | 23320-0663
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Country | US
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Telephone | 757-544-5020
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Fax | 757-227-3642
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Authorized Official
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Title or Position | PRESIDENT
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Name | ULYSESS GRAY
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Credential |
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Telephone | 757-544-5020
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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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