Provider Demographics
NPI:1902614845
Name:POWER OF CHANGE
Entity type:Organization
Organization Name:POWER OF CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DREATHA
Authorized Official - Middle Name:JEANA
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S, NCC
Authorized Official - Phone:618-623-9771
Mailing Address - Street 1:6032 PONTCHARTRAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1934
Mailing Address - Country:US
Mailing Address - Phone:618-623-9771
Mailing Address - Fax:
Practice Address - Street 1:7240 CROWDER BLVD STE 400
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-1923
Practice Address - Country:US
Practice Address - Phone:618-623-9771
Practice Address - Fax:877-250-2283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)