Provider Demographics
NPI:1700026317
Name:ADVANCED COUNSELING FOR CHANGE, PLLC
Entity Type:Organization
Organization Name:ADVANCED COUNSELING FOR CHANGE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:701-351-1182
Mailing Address - Street 1:424 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-3605
Mailing Address - Country:US
Mailing Address - Phone:701-351-1182
Mailing Address - Fax:701-662-6234
Practice Address - Street 1:424 3RD ST SE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-3605
Practice Address - Country:US
Practice Address - Phone:701-351-1182
Practice Address - Fax:701-662-6234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2645251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health