CHANGING LIVES THERAPEUTIC SERVICE, LLC (NPI# 1891317657) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891317657 |
| Entity Type | Organization |
| Organization Name | CHANGING LIVES THERAPEUTIC SERVICE, LLC |
| Practice Address |
413 Mount Cross Rd Ste 102 Danville VA 24540-4089 |
| Mailing Address |
1972 Claim Jumper Trl Winston Salem NC 27127-8007 |
| Practice Telephone | 3365288942 |
| Mailing Telephone | 3365288942 |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2020-05-14 |
| Authorized Official Name | CEMETRIUS ROLLE (CO-OWNER) |
| Authorized Official Telephone | 3365288942 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251S00000X | Community/Behavioral Health | Agencies | ||
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities | ||
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 1922582998 | 05 | |
| NC | 1295117760 | 05 |
| Other Name | Type Code |
|---|---|
| CHANGING LIVES THERAPEUTIC SERVICE,LLC | Doing Business As Name - Organization |
| Street Address |
413 MOUNT CROSS RD STE 102 |
| City | DANVILLE |
| State | VA |
| Zip Code | 24540-4089 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679174981 | Sherry K Hardison | Pharmacist | Walmart, 515 Mount Cross Road, Danville, VA 24540 | 2020-11-03 |
| 1285256412 | Terri Patrice Alston | In Home Supportive Care | 220 Riverside Drive Suite C, Danville, VA 24540 | 2020-05-11 |
| 1619514312 | Glory Days Support Service, LLC | Counselor | 625 Piney Forest Rd, Suite 302c, Same, Danville, VA 24540 | 2019-12-02 |
| 1376189613 | Camilla Petty | Counselor | 265 Piney Forest Road Suite 302 C, Danville, VA 24540 | 2019-11-21 |
| 1891201513 | Jeffrey Langan | Occupational Therapy Assistant | 625 Piney Forest Rd., Danville, VA 24540 | 2017-12-18 |
| 1952822041 | H and G Transportation, LLC | Non-emergency Medical Transport (VAN) | 661 Arnett Blvd., Suite A, Danville, VA 24540 | 2017-06-29 |
| 1518316769 | Precious Nursing LLC | Home Health | 924 Arnett Bvld., Danville, VA 24540 | 2016-06-08 |
| 1487090841 | Hope Family Services LLC | Social Worker | 620 Piney Forest Road Suite, 304-a, Danville, VA 24540 | 2013-05-13 |
| 1336494764 | Jodi Leigh Davis | Speech-Language Pathologist | Center for Pediatric Therapies, 175 Deer Run Road, Danville, VA 24540 | 2012-07-23 |
| 1154618445 | Said Elfayar | Clinical Medical Laboratory | 140 West Parker Rd, Suite A, Danville, VA 24540 | 2011-07-07 |
| Find all providers in zip 24540 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861015745 | Counseling Associates, Inc. | Clinic/Center | 750 Boston St, Danville, AR 72833-7006 | 2020-05-26 |
| 1255822375 | A Village Youth & Family Services Inc. | Clinic/Center | 625 Piney Forest Rd Ste 302d, Danville, VA 24540-2869 | 2018-05-24 |
| 1285153205 | Premier Options, LLC | Clinic/Center | 625 Piney Forest Rd Ste 307c, Danville, VA 24540-2869 | 2017-09-11 |
| 1245754480 | Above and Beyond Mental Health Services | Clinic/Center | 342 Church St, Danville, VA 24540-4420 | 2017-07-31 |
| 1316386477 | Lutheran Social Services of Il | Clinic/Center | 605 N Logan Ave, Danville, IL 61832-4371 | 2013-06-21 |
| 1609917863 | Aunt Martha's Health and Wellness, Inc. | Clinic/Center | 702 N Logan Ave, Danville, IL 61832-4323 | 2007-02-09 |
| 1922019074 | Highland Behavioral Health Services Inc | Clinic/Center | 376 Kenmore Drive, Danville, WV 25053 | 2006-08-11 |
| 1720028608 | New Vista of The Bluegrass Inc | Clinic/Center | 650 High St, Danville, KY 40422-1235 | 2006-06-07 |
| 1114431418 | Rosecrance, Inc. | Clinic/Center | 1222 E Voorhees St, Danville, IL 61834-6249 | 2017-11-22 |
| 1356626527 | Counseling and Psychological Services,llc | Clinic/Center | 1045 Main St, Suite 5, Danville, VA 24541-1800 | 2011-10-19 |
| Find all providers in DANVILLE | ||||
Please comment or provide details below to improve the information on CHANGING LIVES THERAPEUTIC SERVICE, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.