MEDICARE: LEAD CHANGE COUNSELING, PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1700733631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAD CHANGE COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	2536 URBINO CT
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27502-4730
Country	:	US
Telephone Number	:	919-271-8579
Fax Number	:

Provider Business Practice Location Address
First Line	:	4728 OLD US 1 HWY
Second Line	:
City	:	NEW HILL
State	:	NC
Zip	:	27562-9782
Country	:	US
Telephone Number	:	919-271-8579
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMANDA SUPERVILLE
Credential	:	LCSW
Telephone Number	:	919-271-8579

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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