Provider Demographics
NPI:1235427543
Name:CHANGING SEASONS TREATMENT SERVICES INC
Entity Type:Organization
Organization Name:CHANGING SEASONS TREATMENT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:LACAVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCS, LPC, LCAS
Authorized Official - Phone:252-327-1014
Mailing Address - Street 1:PO BOX 8586
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-8586
Mailing Address - Country:US
Mailing Address - Phone:252-695-0203
Mailing Address - Fax:252-695-0207
Practice Address - Street 1:401 W 1ST ST
Practice Address - Street 2:SUITE F
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-1905
Practice Address - Country:US
Practice Address - Phone:252-695-0203
Practice Address - Fax:252-695-0207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health