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General NPI Number Information
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NPI Number | 1821469396
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Entity Type | Organization
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Legal Business Name | CHANGE IN MOTION
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 1850 LEE RD STE 322
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City | WINTER PARK
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State | FL
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Zip | 32789-2107
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Country | US
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Telephone | 407-637-2633
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Fax | 407-558-3438
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Provider Business Mailing Address
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Address Line | 1850 LEE RD STE 322
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City | WINTER PARK
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State | FL
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Zip | 32789-2107
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Country | US
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Telephone | 407-637-2633
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LANICIA CAIN
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Credential |
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Telephone | 407-575-9102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH15376
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License Number State | FL
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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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