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General NPI Number Information
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NPI Number | 1639926603
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Entity Type | Organization
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Legal Business Name | ROADS OF CHANGE COUNSELING, LLC
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Dates
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Enumeration Date | 05/06/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 2708 CLEVELAND RD STE 200
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City | WOOSTER
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State | OH
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Zip | 44691-1703
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Country | US
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Telephone | 234-249-2189
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 E SMITHVILLE WESTERN RD
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City | WOOSTER
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State | OH
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Zip | 44691-1038
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Country | US
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Telephone | 330-635-2113
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | LISA KELLY
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Credential | LISW-S
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Telephone | 234-249-2189
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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 |
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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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