Provider Demographics
NPI:1821645078
Name:EMBRACING CHANGE COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:EMBRACING CHANGE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:N
Authorized Official - Last Name:CANNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCADC
Authorized Official - Phone:201-367-1667
Mailing Address - Street 1:154 JEWETT AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-2004
Mailing Address - Country:US
Mailing Address - Phone:201-892-7651
Mailing Address - Fax:
Practice Address - Street 1:301 S LIVINGSTON AVE STE 205D
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3929
Practice Address - Country:US
Practice Address - Phone:201-367-1667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health