Provider Demographics
NPI:1801409438
Name:CHANGING BY CHOICE
Entity Type:Organization
Organization Name:CHANGING BY CHOICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARCELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MDIV, LPC, LSATP
Authorized Official - Phone:804-495-3000
Mailing Address - Street 1:2510 EDENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-3038
Mailing Address - Country:US
Mailing Address - Phone:804-420-5405
Mailing Address - Fax:804-495-3003
Practice Address - Street 1:6001 LAKESIDE AVE STE 23
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-5748
Practice Address - Country:US
Practice Address - Phone:804-495-3000
Practice Address - Fax:804-495-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health