| Changing Lives Therapeutic Service,llc | |
|
413 Mount Cross Rd Ste 102 Danville VA 24540-4089 | |
| (888) 388-8726 | |
| Not Available |
| Full Name | Changing Lives Therapeutic Service,llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 413 Mount Cross Rd Ste 102, Danville, Virginia |
| Authorized Official Name and Position | Cemetrius Rolle (CO-OWNER) |
| Authorized Official Contact | 9808331121 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Changing Lives Therapeutic Service,llc 8825 University East Dr Ste 200 Charlotte NC 28213-4395 Ph: (980) 833-1121 | Changing Lives Therapeutic Service,llc 413 Mount Cross Rd Ste 102 Danville VA 24540-4089 Ph: (888) 388-8726 |
| NPI Number | 1891317657 |
|---|---|
| Provider Enumeration Date | 05/14/2020 |
| Last Update Date | 06/15/2023 |
| Certification Date | 06/15/2023 |
| Medicare PECOS PAC ID | 1658795331 |
|---|---|
| Medicare Enrollment ID | O20200728002582 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891317657 | NPI | - | NPPES |
| 1295117760 | Medicaid | NC | |
| 1922582998 | Medicaid | NC |
| Provider Name | Cemetrius Teouna Rolle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295117760 PECOS PAC ID: 5991031965 Enrollment ID: I20200728002773 |
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