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General NPI Number Information
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NPI Number | 1720526387
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Entity Type | Organization
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Legal Business Name | A CHANGE OF MIND, LLC
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 01/04/2018
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Provider Practice Location Address
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Address Line | 5020 TAMIAMI TRAIL N SUITE 202
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City | NAPLES
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State | FL
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Zip | 34103
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Country | US
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Telephone | 239-260-4387
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Fax | 844-715-9627
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Provider Business Mailing Address
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Address Line | 5020 TAMIAMI TRAIL N SUITE 202
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City | NAPLES
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State | FL
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Zip | 34103
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Country | US
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Telephone | 239-260-4387
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Fax | 844-715-9627
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Authorized Official
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Title or Position | OWNER
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Name | MRS. HEIDI ANN WILSON
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Credential | LCSW
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Telephone | 239-260-4387
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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 | SW9293
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License Number State | FL
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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 | SW9293
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License Number State | FL
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