Provider Demographics
NPI:1659726214
Name:A CHANGE WITHIN PLLC
Entity Type:Organization
Organization Name:A CHANGE WITHIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DEMAISON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:704-841-9454
Mailing Address - Street 1:250 NORTH TRADE STREET
Mailing Address - Street 2:STE 203
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5040
Mailing Address - Country:US
Mailing Address - Phone:704-841-9454
Mailing Address - Fax:866-834-1817
Practice Address - Street 1:250 NORTH TRADE STREET
Practice Address - Street 2:STE 203
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5040
Practice Address - Country:US
Practice Address - Phone:704-841-9454
Practice Address - Fax:866-834-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0082461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1265854095Medicaid