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General NPI Number Information
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NPI Number | 1467897306
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Entity Type | Organization
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Legal Business Name | CHANGING LIVES FAMILY SERVICES
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Dates
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Enumeration Date | 05/06/2013
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Last Update Date | 05/06/2013
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Provider Practice Location Address
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Address Line | 120 MAGGIE LN
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City | ROXBORO
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State | NC
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Zip | 27573-2661
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Country | US
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Telephone | 704-345-2190
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Fax |
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Provider Business Mailing Address
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Address Line | 120 MAGGIE LN
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City | ROXBORO
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State | NC
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Zip | 27573-2661
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | ROBERT WILLIAMS
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Credential |
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Telephone | 704-345-0190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional 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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #6
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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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