Provider Demographics
NPI:1932360724
Name:WAVES OF CHANGE, PLLC
Entity Type:Organization
Organization Name:WAVES OF CHANGE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER/COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ADAIR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:252-725-0797
Mailing Address - Street 1:104 MARY LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-9416
Mailing Address - Country:US
Mailing Address - Phone:252-241-6156
Mailing Address - Fax:
Practice Address - Street 1:215 N 35TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3185
Practice Address - Country:US
Practice Address - Phone:252-725-0797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2009-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4680101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4680OtherLICENCED PROFESSIONAL COUNSELOR