Provider Demographics
NPI:1700094315
Name:CENTER FOR VALIDATION & CHANGE
Entity Type:Organization
Organization Name:CENTER FOR VALIDATION & CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:218-722-1351
Mailing Address - Street 1:2024 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-2053
Mailing Address - Country:US
Mailing Address - Phone:218-722-1351
Mailing Address - Fax:218-727-0875
Practice Address - Street 1:2024 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-2053
Practice Address - Country:US
Practice Address - Phone:218-722-1351
Practice Address - Fax:218-727-0875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN127911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty