Provider Demographics
NPI:1790976058
Name:CHANGES
Entity Type:Organization
Organization Name:CHANGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KWANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-255-7991
Mailing Address - Street 1:3270 SUNTREE BLVD
Mailing Address - Street 2:SUITE 127
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7530
Mailing Address - Country:US
Mailing Address - Phone:321-255-7991
Mailing Address - Fax:321-639-3207
Practice Address - Street 1:3270 SUNTREE BLVD
Practice Address - Street 2:SUITE 127
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7530
Practice Address - Country:US
Practice Address - Phone:321-255-7991
Practice Address - Fax:321-639-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health