Provider Demographics
NPI:1578126181
Name:SEASON 4 CHANGE, LLC
Entity Type:Organization
Organization Name:SEASON 4 CHANGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:912-508-2582
Mailing Address - Street 1:139 BARNARD AVE SE
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-7203
Mailing Address - Country:US
Mailing Address - Phone:912-508-2582
Mailing Address - Fax:
Practice Address - Street 1:3524 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:GRANITEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29829-9998
Practice Address - Country:US
Practice Address - Phone:803-380-9004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health