Provider Demographics
NPI:1124591094
Name:CHANGING PLACES THERAPEUTIC CENTER, COMPANY
Entity Type:Organization
Organization Name:CHANGING PLACES THERAPEUTIC CENTER, COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BIANCO
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSWS, LCAS-A
Authorized Official - Phone:910-273-9956
Mailing Address - Street 1:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-0542
Mailing Address - Country:US
Mailing Address - Phone:910-273-9956
Mailing Address - Fax:
Practice Address - Street 1:1044 BRAGG BLVD STE B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4512
Practice Address - Country:US
Practice Address - Phone:910-273-9956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health