Provider Demographics
NPI:1912749680
Name:EVALUATIONS FOR CHANGE
Entity type:Organization
Organization Name:EVALUATIONS FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-784-8336
Mailing Address - Street 1:130 W WATER ST UNIT 1287
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-8049
Mailing Address - Country:US
Mailing Address - Phone:732-784-8336
Mailing Address - Fax:732-858-5651
Practice Address - Street 1:130 W WATER ST UNIT 1287
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08754-8049
Practice Address - Country:US
Practice Address - Phone:732-784-8336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty