Provider Demographics
NPI:1982970331
Name:CHANGE AWAITS YOU, PLLC
Entity Type:Organization
Organization Name:CHANGE AWAITS YOU, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RAVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-426-6030
Mailing Address - Street 1:PO BOX 964
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27588-0964
Mailing Address - Country:US
Mailing Address - Phone:919-426-6030
Mailing Address - Fax:
Practice Address - Street 1:7417 KNIGHTDALE BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-8824
Practice Address - Country:US
Practice Address - Phone:919-426-6030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC007264251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health