Provider Demographics
NPI:1598760316
Name:POSITIVE CHANGES, INC
Entity Type:Organization
Organization Name:POSITIVE CHANGES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-788-7878
Mailing Address - Street 1:3200 BEECHLEAF CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1085
Mailing Address - Country:US
Mailing Address - Phone:919-788-7878
Mailing Address - Fax:919-424-8320
Practice Address - Street 1:3200 BEECHLEAF CT
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1085
Practice Address - Country:US
Practice Address - Phone:919-788-7878
Practice Address - Fax:919-424-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0042041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC556410OtherSUSANS VALUEOPTIONS NUMBE
NC7104624OtherAETNA PIN NUMBER
NC5900590Medicaid
NC138YJOtherBCBSNC SUSAN
NCD9225OtherSUSANS MEDCOST
NC7162632OtherAETNA POSITIVE CHANGES
NC6002947Medicaid
NCD9225OtherSUSANS MEDCOST PROVIDER
NC5900590Medicaid
NC7104624OtherAETNA PIN NUMBER
NC556410OtherSUSANS VALUEOPTIONS NUMBE
NC2342313Medicare ID - Type UnspecifiedSUSAN MEDICARE GROUP