Provider Demographics
NPI:1487148359
Name:BE THE CHANGE COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:BE THE CHANGE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-621-2650
Mailing Address - Street 1:1605 WHITE CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:N CHESTERFLD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5449
Mailing Address - Country:US
Mailing Address - Phone:804-621-2650
Mailing Address - Fax:804-369-9709
Practice Address - Street 1:800 BLANTON AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-3603
Practice Address - Country:US
Practice Address - Phone:804-621-2650
Practice Address - Fax:804-369-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040044301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA800002554Medicaid