Provider Demographics
NPI:1285244293
Name:AGAPE CHANGE FAMILY COUNSELING & CONSULTATION SERVICES LLC
Entity type:Organization
Organization Name:AGAPE CHANGE FAMILY COUNSELING & CONSULTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER/ POC
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-755-5585
Mailing Address - Street 1:2128 WILLAMETTE WAY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-6036
Mailing Address - Country:US
Mailing Address - Phone:678-755-5585
Mailing Address - Fax:
Practice Address - Street 1:2128 WILLAMETTE WAY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-6036
Practice Address - Country:US
Practice Address - Phone:678-755-5585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty