Provider Demographics
NPI:1275885469
Name:CENTER FOR WELLNESS & CHANGE, LLC
Entity Type:Organization
Organization Name:CENTER FOR WELLNESS & CHANGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GUNDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-202-8612
Mailing Address - Street 1:1007 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4841
Mailing Address - Country:US
Mailing Address - Phone:434-202-8612
Mailing Address - Fax:434-321-5181
Practice Address - Street 1:1007 E HIGH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4841
Practice Address - Country:US
Practice Address - Phone:434-202-8612
Practice Address - Fax:434-321-5181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012441802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty