Provider Demographics
NPI:1306625868
Name:SME COALITION FOR CHANGE LLC
Entity type:Organization
Organization Name:SME COALITION FOR CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:ETHELIN
Authorized Official - Last Name:KING-DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:210-240-3198
Mailing Address - Street 1:12278 PLANK RD.
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70811-1035
Mailing Address - Country:US
Mailing Address - Phone:225-364-9428
Mailing Address - Fax:225-341-6797
Practice Address - Street 1:12278 PLANK RD.
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70811-1035
Practice Address - Country:US
Practice Address - Phone:225-364-9428
Practice Address - Fax:225-341-6797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty