| Centre For Transitional Change Llc | |
|
242 Creekstone Rdg Woodstock GA 30188-3732 | |
| (470) 546-8346 | |
| Not Available |
| Full Name | Centre For Transitional Change Llc |
|---|---|
| Speciality | Counselor |
| Location | 242 Creekstone Rdg, Woodstock, Georgia |
| Authorized Official Name and Position | Andrea King (OWNER) |
| Authorized Official Contact | 4705468346 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centre For Transitional Change Llc 3595 Canton Rd Ste# 312 Pmb217 Marietta GA 30066 Ph: (470) 546-8346 | Centre For Transitional Change Llc 242 Creekstone Rdg Woodstock GA 30188-3732 Ph: (470) 546-8346 |
| NPI Number | 1831883040 |
|---|---|
| Provider Enumeration Date | 06/08/2023 |
| Last Update Date | 06/08/2023 |
| Certification Date | 06/08/2023 |
| Medicare PECOS PAC ID | 2567805732 |
|---|---|
| Medicare Enrollment ID | O20240206000063 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831883040 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Andrea A King |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487719548 PECOS PAC ID: 3476996646 Enrollment ID: I20240206000096 |
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