Provider Demographics
NPI:1093136491
Name:THE HEALING CENTER FOR CHANGE
Entity Type:Organization
Organization Name:THE HEALING CENTER FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:678-800-1329
Mailing Address - Street 1:PO BOX 723334
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31139-0334
Mailing Address - Country:US
Mailing Address - Phone:678-800-1329
Mailing Address - Fax:
Practice Address - Street 1:3269 OLD CONCORD RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-2642
Practice Address - Country:US
Practice Address - Phone:678-800-1329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006705251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health