| NPI | 1891317657 |
|---|---|
| Doing Business As | CHANGING LIVES THERAPEUTIC SERVICE,LLC |
| Entity Type | Organization |
| Authorized Contact | CEMETRIUS ROLLE Co Owner 980-833-1121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 1041C0700X Social Worker, Clinical | |
| 175T00000X Peer Specialist | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2025-03-24 |