Provider Demographics
NPI:1467699363
Name:CHANGE, LORNA MARIE (LISW)
Entity Type:Individual
Prefix:MS
First Name:LORNA
Middle Name:MARIE
Last Name:CHANGE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:LORNA
Other - Middle Name:MARIE
Other - Last Name:JACKSON-CHANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:4100 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45428-9000
Mailing Address - Country:US
Mailing Address - Phone:937-268-6511
Mailing Address - Fax:937-267-3975
Practice Address - Street 1:4100 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428-9000
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:937-267-3975
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2016-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 11010031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical