Provider Demographics
NPI:1376263608
Name:EMBRACING CHANGE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:EMBRACING CHANGE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CALITA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MADRY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CMFT, NCC
Authorized Official - Phone:678-964-5795
Mailing Address - Street 1:113 ANCIENT OAK LN
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6530
Mailing Address - Country:US
Mailing Address - Phone:561-329-3075
Mailing Address - Fax:
Practice Address - Street 1:205 CORPORATE CENTER DR STE E
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7383
Practice Address - Country:US
Practice Address - Phone:678-964-5795
Practice Address - Fax:678-759-8404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty