Provider Demographics
NPI:1376912253
Name:ELITE CENTER FOR CHANGE
Entity Type:Organization
Organization Name:ELITE CENTER FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COUEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:256-229-3535
Mailing Address - Street 1:1629 4TH AVE SE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4900
Mailing Address - Country:US
Mailing Address - Phone:256-229-3535
Mailing Address - Fax:256-686-2988
Practice Address - Street 1:1629 4TH AVE SE
Practice Address - Street 2:SUITE 113
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4900
Practice Address - Country:US
Practice Address - Phone:256-229-3535
Practice Address - Fax:256-686-2988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty