Provider Demographics
NPI:1881468932
Name:CHANGING THE CYCLE 2 LICENSED CLINICAL SOCIAL WORKER, INC.
Entity type:Organization
Organization Name:CHANGING THE CYCLE 2 LICENSED CLINICAL SOCIAL WORKER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:REESE
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:661-618-6280
Mailing Address - Street 1:44349 LOWTREE AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4104
Mailing Address - Country:US
Mailing Address - Phone:661-618-6280
Mailing Address - Fax:205-509-5337
Practice Address - Street 1:44349 LOWTREE AVE STE 111
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4104
Practice Address - Country:US
Practice Address - Phone:661-228-0567
Practice Address - Fax:205-509-5377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health