| Inspired By Change | |
|
6490 Kelmscot Ct Fayetteville NC 28303-5674 | |
| (910) 835-6895 | |
| Not Available |
| Full Name | Inspired By Change |
|---|---|
| Speciality | Social Worker |
| Location | 6490 Kelmscot Ct, Fayetteville, North Carolina |
| Authorized Official Name and Position | Justin Fendell Green (OWNER) |
| Authorized Official Contact | 9108356895 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Inspired By Change 2754 Shellbark Rd # A Decatur GA 30035-4113 Ph: (910) 475-8048 | Inspired By Change 6490 Kelmscot Ct Fayetteville NC 28303-5674 Ph: (910) 835-6895 |
| NPI Number | 1962182493 |
|---|---|
| Provider Enumeration Date | 07/19/2023 |
| Last Update Date | 11/12/2024 |
| Certification Date | 11/12/2024 |
| Medicare PECOS PAC ID | 1850820085 |
|---|---|
| Medicare Enrollment ID | O20250131003516 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962182493 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Justin Fendell Green |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497429856 PECOS PAC ID: 2466988365 Enrollment ID: I20241214000317 |
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