Provider Demographics
NPI:1497210256
Name:GREATER CHANGES LLC.
Entity Type:Organization
Organization Name:GREATER CHANGES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARIK
Authorized Official - Middle Name:MALACHI
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:340-332-2717
Mailing Address - Street 1:PO BOX 411
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00821-0411
Mailing Address - Country:US
Mailing Address - Phone:340-332-2717
Mailing Address - Fax:
Practice Address - Street 1:40 EG LAGRANGE
Practice Address - Street 2:
Practice Address - City:FREDERIKSTED
Practice Address - State:VI
Practice Address - Zip Code:00841-0084
Practice Address - Country:US
Practice Address - Phone:340-332-2717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI2-43354-1LOtherVIRGIN ISLANDS DEPARTMENT OF LICENSING AND CONSUMER AFFAIRS