Provider Demographics
NPI:1013801117
Name:SEASONS OF CHANGE LICENSED CLINICAL SOCIAL WORKER INC
Entity type:Organization
Organization Name:SEASONS OF CHANGE LICENSED CLINICAL SOCIAL WORKER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:760-428-2776
Mailing Address - Street 1:20288 W VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-8614
Mailing Address - Country:US
Mailing Address - Phone:760-428-2776
Mailing Address - Fax:760-560-2079
Practice Address - Street 1:20288 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-8614
Practice Address - Country:US
Practice Address - Phone:760-428-2776
Practice Address - Fax:760-560-2079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty