Provider Demographics
NPI:1821546995
Name:CHANGE AGENTS COUNSELING & CONSULTING, LLC
Entity Type:Organization
Organization Name:CHANGE AGENTS COUNSELING & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARRIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-207-9359
Mailing Address - Street 1:PO BOX 1048
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30085-1048
Mailing Address - Country:US
Mailing Address - Phone:404-207-9359
Mailing Address - Fax:
Practice Address - Street 1:5115 CHASTLETON DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-1443
Practice Address - Country:US
Practice Address - Phone:404-207-9359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health