Provider Demographics
NPI:1285489765
Name:BE THE CHANGE COMMUNITY SERVICES
Entity type:Organization
Organization Name:BE THE CHANGE COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARQUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-372-1086
Mailing Address - Street 1:149 W WASHINGTON ST APT 107
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-5270
Mailing Address - Country:US
Mailing Address - Phone:757-372-1086
Mailing Address - Fax:
Practice Address - Street 1:468 INVESTORS PL STE 204E
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1109
Practice Address - Country:US
Practice Address - Phone:757-372-1086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty