Provider Demographics
NPI:1831883040
Name:CENTRE FOR TRANSITIONAL CHANGE LLC
Entity type:Organization
Organization Name:CENTRE FOR TRANSITIONAL CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:470-546-8346
Mailing Address - Street 1:3595 CANTON RD STE# 312 PMB217
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066
Mailing Address - Country:US
Mailing Address - Phone:470-546-8346
Mailing Address - Fax:
Practice Address - Street 1:225 CREEKSTONE RDG STE 2
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3744
Practice Address - Country:US
Practice Address - Phone:470-546-8346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty