Provider Demographics
NPI:1033572540
Name:A CENTER 4 CHANGE
Entity Type:Organization
Organization Name:A CENTER 4 CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:JUDD
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:606-393-5586
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-5074
Mailing Address - Country:US
Mailing Address - Phone:606-393-5586
Mailing Address - Fax:
Practice Address - Street 1:5900 US 60 W
Practice Address - Street 2:SUITE B
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101
Practice Address - Country:US
Practice Address - Phone:606-393-5586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0138351016103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty