Provider Demographics
NPI:1811120298
Name:CHANGE AGENTS NETWORK, LLC
Entity type:Organization
Organization Name:CHANGE AGENTS NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:CAPRICE
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:912-210-6855
Mailing Address - Street 1:PO BOX 2532
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31402-2532
Mailing Address - Country:US
Mailing Address - Phone:912-210-6855
Mailing Address - Fax:888-753-1005
Practice Address - Street 1:506 BLAIR ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-5100
Practice Address - Country:US
Practice Address - Phone:912-210-6855
Practice Address - Fax:888-753-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health