Provider Demographics
NPI:1952150831
Name:CHANGE22, LLC
Entity type:Organization
Organization Name:CHANGE22, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STRODE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-347-0450
Mailing Address - Street 1:733 THIMBLE SHOALS BLVD
Mailing Address - Street 2:SUITE 170, OFFICE 102
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4260
Mailing Address - Country:US
Mailing Address - Phone:757-347-0450
Mailing Address - Fax:757-347-0460
Practice Address - Street 1:733 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE 170, OFFICE 102
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4260
Practice Address - Country:US
Practice Address - Phone:757-347-0450
Practice Address - Fax:757-347-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)