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General NPI Number Information
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NPI Number | 1568094225
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Entity Type | Organization
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Legal Business Name | A CHANCE FOR CHANGE LLC
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 999 WATERSIDE DR STE 2525
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City | NORFOLK
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State | VA
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Zip | 23510-3316
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Country | US
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Telephone | 757-777-3454
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Fax | 757-568-7437
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Provider Business Mailing Address
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Address Line | 999 WATERSIDE DR STE 2525
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City | NORFOLK
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State | VA
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Zip | 23510-3316
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Country | US
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Telephone | 757-777-3454
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Fax | 757-568-7437
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. AMANDA COLEMON
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Credential | BA, PSYCHOLOGY, QMHP
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Telephone | 980-745-9867
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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 | 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 #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 225C00000X
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Taxonomy Name | Rehabilitation 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 | 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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Taxonomy #6
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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