=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740428614
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMBRACING CHANGE CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2009
-----------------------------------------------------
Last Update Date | 01/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1621 EASTERN AVE
-----------------------------------------------------
City | ROCKY MOUNT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27801-6274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-442-0012
-----------------------------------------------------
Fax | 252-442-0013
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1621 EASTERN AVE
-----------------------------------------------------
City | ROCKY MOUNT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27801-6274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-442-0012
-----------------------------------------------------
Fax | 242-442-0013
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | CAROLYN B WESTERN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-442-0012
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | MHL-033-060
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------