Provider Demographics
NPI:1225594922
Name:SOUTHERN CHANGE BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:SOUTHERN CHANGE BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, QMHP-A/C
Authorized Official - Phone:804-239-9597
Mailing Address - Street 1:8109 MECHANICSVILLE TPKE UNIT 2A
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-1209
Mailing Address - Country:US
Mailing Address - Phone:804-446-4706
Mailing Address - Fax:
Practice Address - Street 1:8109 MECHANICSVILLE TPKE UNIT 2A
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-1209
Practice Address - Country:US
Practice Address - Phone:804-446-4706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty