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General NPI Number Information
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NPI Number | 1740977016
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Entity Type | Organization
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Legal Business Name | CHANGE WITHIN YOUR REACH
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 04/18/2023
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Provider Practice Location Address
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Address Line | 3126 EMERYWOOD RD
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City | EASTOVER
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State | NC
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Zip | 28312-8582
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Country | US
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Telephone | 984-238-5756
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Fax |
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Provider Business Mailing Address
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Address Line | 285 AMBERGATE DR
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City | YOUNGSVILLE
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State | NC
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Zip | 27596-7447
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Country | US
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Telephone | 910-474-3192
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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. JAMES SMITH
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Credential |
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Telephone | 910-474-3192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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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 |
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License Number State |
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