Provider Demographics
NPI:1689852758
Name:ALLIANCE FOR CHANGE
Entity Type:Organization
Organization Name:ALLIANCE FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROSENAU
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:770-813-1544
Mailing Address - Street 1:2250 SATELLITE BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4906
Mailing Address - Country:US
Mailing Address - Phone:770-813-1544
Mailing Address - Fax:770-813-1545
Practice Address - Street 1:2250 SATELLITE BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4906
Practice Address - Country:US
Practice Address - Phone:770-813-1544
Practice Address - Fax:770-813-1545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1209103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty