Provider Demographics
NPI:1609052356
Name:BLUEPRINT FOR CHANGE
Entity Type:Organization
Organization Name:BLUEPRINT FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:SINGLETON
Authorized Official - Last Name:TABOR
Authorized Official - Suffix:
Authorized Official - Credentials:CACII, LICDC
Authorized Official - Phone:843-524-6112
Mailing Address - Street 1:1110 PARIS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-2322
Mailing Address - Country:US
Mailing Address - Phone:843-524-6112
Mailing Address - Fax:843-524-6111
Practice Address - Street 1:1110 PARIS AVE STE A
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-2322
Practice Address - Country:US
Practice Address - Phone:843-524-6112
Practice Address - Fax:843-524-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health