MEDICARE: ROADS OF CHANGE COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1639926603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROADS OF CHANGE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	2001 E SMITHVILLE WESTERN RD
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-1038
Country	:	US
Telephone Number	:	330-635-2113
Fax Number	:

Provider Business Practice Location Address
First Line	:	2708 CLEVELAND RD STE 200
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-1703
Country	:	US
Telephone Number	:	234-249-2189
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	LISA KELLY
Credential	:	LISW-S
Telephone Number	:	234-249-2189

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	10/15/2024

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