Organization Name: | ALL ABOUT CHANGE |
NPI Number: | 1003167990 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KELLY ROSEBERRY (EXECUTIVE DIRECTOR) |
Mailing Address: | 850 Wade Hampton Blvd Suite C Greenville |
State: | SC US |
Postal Code: | 296094945 |
Phone Number: | 8647040931 |
Fax Number: | |
NPI Enumeration Date: | 10/02/2012 |
NPI Last Update Date: | 10/02/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 5080 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | SC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |