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General NPI Number Information
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NPI Number | 1528777158
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Entity Type | Organization
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Legal Business Name | JOURNEY THROUGH CHANGE LLC
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Dates
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Enumeration Date | 11/22/2022
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 1129 N WASHINGTON AVE
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City | LANSING
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State | MI
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Zip | 48906-4842
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Country | US
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Telephone | 734-531-7763
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Fax |
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Provider Business Mailing Address
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Address Line | 1408 BISCAYNE WAY
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City | HASLETT
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State | MI
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Zip | 48840-8410
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Country | US
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Telephone | 517-410-8512
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. JESSICA MARIE CHARRON
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Credential | PSY.D./L.P.
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Telephone | 518-410-8512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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