| Change Academy At Lake Of The Ozarks | |
|
20116 Ashbrook Pl Ste 110 Ashburn VA 20147-5086 | |
| (480) 550-9281 | |
| Not Available |
| Full Name | Change Academy At Lake Of The Ozarks |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 20116 Ashbrook Pl Ste 110, Ashburn, Virginia |
| Authorized Official Name and Position | Sharnell Spencer (CREDENTIALING MANAGER) |
| Authorized Official Contact | 6612396923 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Change Academy At Lake Of The Ozarks 5500 Ming Ave Ste 410 Bakersfield CA 93309-4631 Ph: (661) 622-4132 | Change Academy At Lake Of The Ozarks 20116 Ashbrook Pl Ste 110 Ashburn VA 20147-5086 Ph: (480) 550-9281 |
| NPI Number | 1568188340 |
|---|---|
| Provider Enumeration Date | 10/13/2022 |
| Last Update Date | 05/21/2025 |
| Certification Date | 05/21/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568188340 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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