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General NPI Number Information
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NPI Number | 1780576355
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE CHANGE AND WELLNESS LLC
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 11 MIDWAY CT
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City | BARNEGAT
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State | NJ
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Zip | 08005-1848
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Country | US
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Telephone | 609-661-4781
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Fax |
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Provider Business Mailing Address
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Address Line | 11 MIDWAY CT
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City | BARNEGAT
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State | NJ
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Zip | 08005-1848
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Country | US
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Telephone | 609-661-4781
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | NICHOLAS LEON
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Credential | MA, LPC, NCC, BCC
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Telephone | 609-661-4781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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