Provider Demographics
NPI:1881120459
Name:CHANGING DIRECTIONS COUNSELING & CONSULTING, LLC
Entity type:Organization
Organization Name:CHANGING DIRECTIONS COUNSELING & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER-EARL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-BACS
Authorized Official - Phone:936-715-8293
Mailing Address - Street 1:PO BOX 2004
Mailing Address - Street 2:5019 SHREVEPORT HWY
Mailing Address - City:TIOGA
Mailing Address - State:LA
Mailing Address - Zip Code:71477-9998
Mailing Address - Country:US
Mailing Address - Phone:936-715-8293
Mailing Address - Fax:
Practice Address - Street 1:5920 COLISEUM BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3714
Practice Address - Country:US
Practice Address - Phone:318-443-9339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA110311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty