Provider Demographics
NPI:1235951450
Name:COUNSELING & CONSULTING FOR MEANINGFUL CHANGE, LLC
Entity type:Organization
Organization Name:COUNSELING & CONSULTING FOR MEANINGFUL CHANGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:434-316-6025
Mailing Address - Street 1:1107 COTTONTOWN MANOR DR APT 302
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2539
Mailing Address - Country:US
Mailing Address - Phone:434-238-7709
Mailing Address - Fax:
Practice Address - Street 1:110 VISTA CENTRE DR STE 18
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2785
Practice Address - Country:US
Practice Address - Phone:434-316-6025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty