Provider Demographics
NPI:1871018788
Name:CHANGING LIVES AND STAYING SOBER
Entity Type:Organization
Organization Name:CHANGING LIVES AND STAYING SOBER
Other - Org Name:C.L.A.S.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:313-784-0202
Mailing Address - Street 1:17405 LAHSER RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2334
Mailing Address - Country:US
Mailing Address - Phone:313-412-2160
Mailing Address - Fax:
Practice Address - Street 1:17405 LAHSER RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-2334
Practice Address - Country:US
Practice Address - Phone:313-412-2160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2023-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 174H00000X, 202D00000X, 261QM0801X, 261QR0800X
MISA0822584251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care