Provider Demographics
NPI:1336685973
Name:CHANGE BY CHOICE LLC
Entity Type:Organization
Organization Name:CHANGE BY CHOICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/ MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:ED S, LMFT, LMHC
Authorized Official - Phone:352-575-8344
Mailing Address - Street 1:4715 NW 53RD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-4856
Mailing Address - Country:US
Mailing Address - Phone:352-575-8344
Mailing Address - Fax:
Practice Address - Street 1:4715 NW 53RD AVE STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-4856
Practice Address - Country:US
Practice Address - Phone:352-575-8344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9295101YM0800X
FLMT2959106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMT 2959OtherDOH, LMFT
FLMH9295OtherDOH, LMHC