Provider Demographics
NPI:1114356649
Name:CHANGING COURSE COUNSELING, PLC
Entity Type:Organization
Organization Name:CHANGING COURSE COUNSELING, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:810-357-9318
Mailing Address - Street 1:1423 PINE GROVE AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060
Mailing Address - Country:US
Mailing Address - Phone:810-357-9318
Mailing Address - Fax:810-479-9684
Practice Address - Street 1:1423 PINE GROVE AVENUE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060
Practice Address - Country:US
Practice Address - Phone:810-357-9318
Practice Address - Fax:810-479-9684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty