Provider Demographics
NPI:1790812386
Name:CENTER FOR CHANGE OF FLORIDA
Entity Type:Organization
Organization Name:CENTER FOR CHANGE OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:941-955-5518
Mailing Address - Street 1:2801 FRUITVILLE ROAD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237
Mailing Address - Country:US
Mailing Address - Phone:941-955-5518
Mailing Address - Fax:941-330-1966
Practice Address - Street 1:2801 FRUITVILLE RD
Practice Address - Street 2:SUITE 260
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-5343
Practice Address - Country:US
Practice Address - Phone:941-955-5518
Practice Address - Fax:941-330-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4238101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty