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General NPI Number Information
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NPI Number | 1487148359
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Entity Type | Organization
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Legal Business Name | BE THE CHANGE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 800 BLANTON AVE
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City | RICHMOND
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State | VA
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Zip | 23221-3603
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Country | US
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Telephone | 804-621-2650
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Fax | 804-369-9709
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Provider Business Mailing Address
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Address Line | 1605 WHITE CEDAR LN
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City | N CHESTERFLD
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State | VA
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Zip | 23235-5449
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Country | US
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Telephone | 804-621-2650
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Fax | 804-369-9709
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARY ANNE TAYLOR
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Credential | LCSW
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Telephone | 804-621-2650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904004430
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License Number State | VA
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