Provider Demographics
NPI:1407083959
Name:CHANGING SEASONS COUNSELING SEVICE
Entity Type:Organization
Organization Name:CHANGING SEASONS COUNSELING SEVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURGER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,LCAS, ICAADC,
Authorized Official - Phone:910-975-3461
Mailing Address - Street 1:PO BOX 1572
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28002-1572
Mailing Address - Country:US
Mailing Address - Phone:704-984-4910
Mailing Address - Fax:704-984-4914
Practice Address - Street 1:1040 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-5017
Practice Address - Country:US
Practice Address - Phone:704-984-4910
Practice Address - Fax:704-984-4914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5176101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty