Provider Demographics
NPI:1811290018
Name:FACING CHANGE, P.A.
Entity type:Organization
Organization Name:FACING CHANGE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREENLAW
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:207-784-0922
Mailing Address - Street 1:4 PARK ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7172
Mailing Address - Country:US
Mailing Address - Phone:207-784-0922
Mailing Address - Fax:207-784-6143
Practice Address - Street 1:4 PARK ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7172
Practice Address - Country:US
Practice Address - Phone:207-784-0922
Practice Address - Fax:207-784-6143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC4790251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME129500000Medicaid