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General NPI Number Information
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NPI Number | 1376912253
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Entity Type | Organization
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Legal Business Name | ELITE CENTER FOR CHANGE
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Dates
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Enumeration Date | 09/21/2015
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 1629 4TH AVE SE SUITE 113
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City | DECATUR
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State | AL
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Zip | 35601-4900
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Country | US
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Telephone | 256-229-3535
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Fax | 256-686-2988
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Provider Business Mailing Address
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Address Line | 1629 4TH AVE SE SUITE 113
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City | DECATUR
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State | AL
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Zip | 35601-4900
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Country | US
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Telephone | 256-229-3535
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Fax | 256-686-2988
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MICHELLE COUEY
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Credential | LCSW
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Telephone | 256-229-3535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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