Provider Demographics
NPI:1457668592
Name:POSITIVE CHANGE COUNSELING SERVICES, A PROFESSIONAL CORPORATION OF MAR
Entity Type:Organization
Organization Name:POSITIVE CHANGE COUNSELING SERVICES, A PROFESSIONAL CORPORATION OF MAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMELITA
Authorized Official - Middle Name:ECHO
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LPPC
Authorized Official - Phone:707-446-8600
Mailing Address - Street 1:2050 PEABODY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6695
Mailing Address - Country:US
Mailing Address - Phone:707-446-8600
Mailing Address - Fax:707-446-8100
Practice Address - Street 1:2050 PEABODY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6695
Practice Address - Country:US
Practice Address - Phone:707-446-8600
Practice Address - Fax:707-446-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25655103TC0700X
CAMFC46660106H00000X, 106H00000X
CAIMF85828106H00000X
CAMFC77756106H00000X
CAIMF88962106H00000X
CAMFC41338106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1972810489OtherMFT INTERN