Provider Demographics
NPI:1902412695
Name:EMERGING FOR CHANGE
Entity Type:Organization
Organization Name:EMERGING FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICKA
Authorized Official - Middle Name:FRIZELL
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:703-350-7752
Mailing Address - Street 1:108 N GORDON ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2406
Mailing Address - Country:US
Mailing Address - Phone:703-350-7752
Mailing Address - Fax:
Practice Address - Street 1:11350 RANDOM HILLS RD STE 800
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6044
Practice Address - Country:US
Practice Address - Phone:703-350-7752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)