Provider Demographics
NPI:1659782332
Name:UPWARD CHANGE HEALTH SERVICE
Entity Type:Organization
Organization Name:UPWARD CHANGE HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEAM LEAD, CLINICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:MACHELLE-KELLY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-A
Authorized Official - Phone:910-778-3049
Mailing Address - Street 1:807 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-4074
Mailing Address - Country:US
Mailing Address - Phone:919-682-5300
Mailing Address - Fax:
Practice Address - Street 1:807 E MAIN ST
Practice Address - Street 2:APT 2931
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-4074
Practice Address - Country:US
Practice Address - Phone:919-682-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP007600253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care