Provider Demographics
NPI:1972138386
Name:A ND T HOPE 4 CHANGE
Entity Type:Organization
Organization Name:A ND T HOPE 4 CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGASSI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:209-718-0660
Mailing Address - Street 1:1101 STANDIFORD AVE STE B6
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0981
Mailing Address - Country:US
Mailing Address - Phone:209-718-0660
Mailing Address - Fax:
Practice Address - Street 1:1101 STANDIFORD AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0982
Practice Address - Country:US
Practice Address - Phone:209-579-3301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty