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General NPI Number Information
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NPI Number | 1659744035
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Entity Type | Organization
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Legal Business Name | GUIDING CHANGE PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 11/10/2015
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Provider Practice Location Address
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Address Line | 5049 RINGWOOD MDW SUITE A
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City | SARASOTA
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State | FL
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Zip | 34235-2035
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Country | US
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Telephone | 941-342-7390
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 52284
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City | SARASOTA
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State | FL
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Zip | 34232-0319
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Country | US
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Telephone | 941-342-7390
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. WILLIAM RODRIGUEZ JR.
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Credential | LCSW
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Telephone | 908-581-5574
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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 | SW12841
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License Number State | FL
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