Provider Demographics
NPI:1972833218
Name:SUNLIGHT CENTER FOR CHANGE
Entity Type:Organization
Organization Name:SUNLIGHT CENTER FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JINDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:520-344-0056
Mailing Address - Street 1:120 S HOUGHTON RD
Mailing Address - Street 2:#138-200
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-6731
Mailing Address - Country:US
Mailing Address - Phone:520-344-0056
Mailing Address - Fax:
Practice Address - Street 1:780 N PROMONTORY DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-3545
Practice Address - Country:US
Practice Address - Phone:520-344-0056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3963103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty