Provider Demographics
NPI:1154840791
Name:CONSTANT CHANGE TX LLC
Entity Type:Organization
Organization Name:CONSTANT CHANGE TX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELONDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-922-7028
Mailing Address - Street 1:7633 HULL STREET RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6481
Mailing Address - Country:US
Mailing Address - Phone:804-359-2100
Mailing Address - Fax:757-299-2576
Practice Address - Street 1:7633 HULL STREET RD STE 100
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-6481
Practice Address - Country:US
Practice Address - Phone:804-359-2100
Practice Address - Fax:757-299-2576
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONSTANT CHANGE ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-14
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2502101YM0800X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty