Provider Demographics
NPI:1447704804
Name:THE TRANSFORMATION CENTER
Entity type:Organization
Organization Name:THE TRANSFORMATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:713-906-1350
Mailing Address - Street 1:416 HAMPTON XING
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-4060
Mailing Address - Country:US
Mailing Address - Phone:713-906-1350
Mailing Address - Fax:
Practice Address - Street 1:416 HAMPTON XING
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-4060
Practice Address - Country:US
Practice Address - Phone:713-906-1350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health