Provider Demographics
NPI:1659827715
Name:CHANGING PATHS COUNSELING CENTER PLLC
Entity Type:Organization
Organization Name:CHANGING PATHS COUNSELING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BOYD-GILYARD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:336-508-8231
Mailing Address - Street 1:117 WARD RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-9651
Mailing Address - Country:US
Mailing Address - Phone:336-508-8231
Mailing Address - Fax:
Practice Address - Street 1:1600 E WENDOER AVE.
Practice Address - Street 2:SUITE C
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405
Practice Address - Country:US
Practice Address - Phone:336-508-8231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC009771251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health