Provider Demographics
NPI:1639569049
Name:THREE TREES CENTER FOR CHANGE
Entity Type:Organization
Organization Name:THREE TREES CENTER FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCFC,CCSOTS
Authorized Official - Phone:803-207-0558
Mailing Address - Street 1:PO BOX 4965
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-6965
Mailing Address - Country:US
Mailing Address - Phone:803-207-0558
Mailing Address - Fax:877-752-1347
Practice Address - Street 1:546 S CHERRY RD
Practice Address - Street 2:SUITE L
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3487
Practice Address - Country:US
Practice Address - Phone:803-207-0558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health