Provider Demographics
NPI:1376892679
Name:THE CENTER FOR CHANGE, LLC
Entity Type:Organization
Organization Name:THE CENTER FOR CHANGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:401-465-2670
Mailing Address - Street 1:1045 WARWICK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3665
Mailing Address - Country:US
Mailing Address - Phone:401-465-2670
Mailing Address - Fax:401-270-0660
Practice Address - Street 1:1045 WARWICK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3665
Practice Address - Country:US
Practice Address - Phone:401-465-2670
Practice Address - Fax:401-270-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty