=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982423844
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEAVES OF CHANGE COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2024
-----------------------------------------------------
Last Update Date | 10/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1420 MARY AVE
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23502-2211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-656-9281
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 440 MONTICELLO AVE STE 1802
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23510-2670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-656-9281
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. ELIZABETH CARRANO
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 757-656-9281
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------