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General NPI Number Information
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NPI Number | 1699063297
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Entity Type | Organization
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Legal Business Name | AFFECTING CHANGE, LLC
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Dates
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Enumeration Date | 07/16/2011
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Last Update Date | 03/21/2022
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Provider Practice Location Address
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Address Line | 22511 TELEGRAPH RD STE 128
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City | SOUTHFIELD
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State | MI
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Zip | 48033-4130
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Country | US
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Telephone | 248-905-1126
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Fax | 313-209-8989
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Provider Business Mailing Address
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Address Line | 22511 TELEGRAPH RD STE 128
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City | SOUTHFIELD
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State | MI
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Zip | 48033-4130
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Country | US
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Telephone | 248-905-1126
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Fax | 313-209-8989
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANDRE D CHARLEY
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Credential | MSW
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Telephone | 313-587-9869
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | D25724
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License Number State | MI
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