Provider Demographics
NPI:1528707643
Name:CHANGING LANES INTERVENTION HUMAN SERVICES
Entity type:Organization
Organization Name:CHANGING LANES INTERVENTION HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,LBA,BCBA,CRPS
Authorized Official - Phone:770-580-4116
Mailing Address - Street 1:500 LANIER AVE W STE 608
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7644
Mailing Address - Country:US
Mailing Address - Phone:770-256-3977
Mailing Address - Fax:888-522-1055
Practice Address - Street 1:500 LANIER AVE W STE 608
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7644
Practice Address - Country:US
Practice Address - Phone:770-580-4116
Practice Address - Fax:888-522-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty