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General NPI Number Information
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NPI Number | 1801409438
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Entity Type | Organization
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Legal Business Name | CHANGING BY CHOICE
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 6001 LAKESIDE AVE STE 23
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City | HENRICO
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State | VA
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Zip | 23228-5748
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Country | US
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Telephone | 804-495-3000
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Fax | 804-495-3003
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Provider Business Mailing Address
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Address Line | 2510 EDENBROOK DR
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City | HENRICO
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State | VA
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Zip | 23228-3038
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Country | US
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Telephone | 804-420-5405
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Fax | 804-495-3003
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Authorized Official
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Title or Position | CEO
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Name | MRS. ARCELIA MILLER-JACKSON
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Credential | MA, MDIV, LPC, LSATP
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Telephone | 804-495-3000
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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 |
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License Number State |
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Taxonomy #2
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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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