Provider Demographics
NPI:1083422604
Name:CREATING CHANCES OF CHANGE BEHAVIORAL & MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:CREATING CHANCES OF CHANGE BEHAVIORAL & MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEENEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-774-9633
Mailing Address - Street 1:355 CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2816
Mailing Address - Country:US
Mailing Address - Phone:833-774-9633
Mailing Address - Fax:888-623-8077
Practice Address - Street 1:355 CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2816
Practice Address - Country:US
Practice Address - Phone:833-774-9633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-28
Last Update Date:2025-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health