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General NPI Number Information
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NPI Number | 1659932515
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Entity Type | Organization
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Legal Business Name | CULTURE CHANGE PROJECT, LLC
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Dates
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Enumeration Date | 06/21/2019
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Last Update Date | 06/21/2019
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Provider Practice Location Address
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Address Line | 1158 MASSACHUSETTS AVE UNIT 306
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City | CAMBRIDGE
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State | MA
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Zip | 02138-5205
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Country | US
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Telephone | 617-402-5653
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Fax |
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Provider Business Mailing Address
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Address Line | 82 NORMANDY AVE
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City | CAMBRIDGE
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State | MA
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Zip | 02138-1017
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Country | US
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Telephone | 479-595-4077
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | RAMSEY CHAMPAGNE
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Credential | LMHC
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Telephone | 479-595-4077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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