Provider Demographics
NPI:1053450817
Name:CENTER FOR PERSONAL GROWTH & CHANGE
Entity Type:Organization
Organization Name:CENTER FOR PERSONAL GROWTH & CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-227-3072
Mailing Address - Street 1:6350 CENTER DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4107
Mailing Address - Country:US
Mailing Address - Phone:757-227-3072
Mailing Address - Fax:757-227-3212
Practice Address - Street 1:6350 CENTER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4107
Practice Address - Country:US
Practice Address - Phone:757-227-3072
Practice Address - Fax:757-227-3212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty