Provider Demographics
NPI:1144658170
Name:CHANGING STRIDES COUNSELING, LLC
Entity type:Organization
Organization Name:CHANGING STRIDES COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:N
Authorized Official - Last Name:HERBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-944-0810
Mailing Address - Street 1:123 LOBLOLLY PINE DR.
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678
Mailing Address - Country:US
Mailing Address - Phone:404-944-0810
Mailing Address - Fax:
Practice Address - Street 1:123 LOBLOLLY PINE DR.
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678
Practice Address - Country:US
Practice Address - Phone:404-944-0810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSW.10528-CP251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health