Provider Demographics
NPI:1770349268
Name:EMBRACE YOUR CHANGE LLC
Entity type:Organization
Organization Name:EMBRACE YOUR CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VESPICO-MULL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, SAP, ICAADC
Authorized Official - Phone:484-577-3760
Mailing Address - Street 1:293 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-6072
Mailing Address - Country:US
Mailing Address - Phone:610-763-2411
Mailing Address - Fax:843-208-6168
Practice Address - Street 1:293 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-6072
Practice Address - Country:US
Practice Address - Phone:610-763-2411
Practice Address - Fax:843-208-6168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty