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General NPI Number Information
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NPI Number | 1902169022
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Entity Type | Organization
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Legal Business Name | CENTER FOR CHANGE AND GROWTH, LLC
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 06/22/2012
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Provider Practice Location Address
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Address Line | 7401 WILES RD SUITE 127
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-2036
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Country | US
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Telephone | 954-214-7986
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Fax |
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Provider Business Mailing Address
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Address Line | 7401 WILES RD SUITE 127
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-2036
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Country | US
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Telephone | 954-214-7986
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST/OWNER
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Name | INGRID JONES
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Credential | LMHC
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Telephone | 954-214-7986
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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 | MH10957
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License Number State | FL
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