Provider Demographics
NPI:1144616848
Name:A POSITIVE CHANGE
Entity Type:Organization
Organization Name:A POSITIVE CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:BOLEY PSYD
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:253-225-2275
Mailing Address - Street 1:5262 OLYMPIC DRIVE SUITE C
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335
Mailing Address - Country:US
Mailing Address - Phone:253-225-2275
Mailing Address - Fax:
Practice Address - Street 1:5262 OLYMPIC DRIVE SUITE C
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335
Practice Address - Country:US
Practice Address - Phone:253-225-2275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60429375251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH60429375OtherLMHC LH60429375