Provider Demographics
NPI:1932795093
Name:APPETITE 4 CHANGE LLC
Entity Type:Organization
Organization Name:APPETITE 4 CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NUTRITIONIST/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMEKIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:CN
Authorized Official - Phone:571-577-8683
Mailing Address - Street 1:644 BURNSIDE TER SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-8936
Mailing Address - Country:US
Mailing Address - Phone:571-577-8683
Mailing Address - Fax:
Practice Address - Street 1:644 BURNSIDE TER SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-8936
Practice Address - Country:US
Practice Address - Phone:571-577-8683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty