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General NPI Number Information
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NPI Number | 1518265958
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Entity Type | Organization
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Legal Business Name | POSITIVE CHANGE
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Dates
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Enumeration Date | 03/09/2011
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Last Update Date | 03/09/2011
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Provider Practice Location Address
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Address Line | 1120 N CIRCLE DR #11
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-3156
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Country | US
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Telephone | 719-578-9730
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Fax | 729-473-7759
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Provider Business Mailing Address
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Address Line | 1120 N CIRCLE DR #11
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-3156
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Country | US
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Telephone | 719-578-9730
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Fax | 729-473-7759
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. MARY KATHERINE WHITT
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Credential | LCSW
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Telephone | 719-578-9730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 992160
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License Number State | CO
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