Provider Demographics
NPI:1407610215
Name:EMBRACE THE CHANGE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:EMBRACE THE CHANGE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DAUGHENBAUGH
Authorized Official - Suffix:JR
Authorized Official - Credentials:LISAC
Authorized Official - Phone:026-730-5206
Mailing Address - Street 1:3420 E SHEA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3348
Mailing Address - Country:US
Mailing Address - Phone:602-730-5206
Mailing Address - Fax:
Practice Address - Street 1:3420 E SHEA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3348
Practice Address - Country:US
Practice Address - Phone:602-730-5206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty