Provider Demographics
NPI:1013673516
Name:EMERGENT CHANGE COUNSELING & HEALING
Entity type:Organization
Organization Name:EMERGENT CHANGE COUNSELING & HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:862-252-4001
Mailing Address - Street 1:125 GLENRIDGE AVE UNIT 289
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-6812
Mailing Address - Country:US
Mailing Address - Phone:973-671-4309
Mailing Address - Fax:973-629-1778
Practice Address - Street 1:18-20 LACKAWANNA PLZ STE 300
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3642
Practice Address - Country:US
Practice Address - Phone:973-671-4309
Practice Address - Fax:973-629-1778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty