# THERAPEUTIC CENTER FOR CHANGE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598381030
- **Authorized official:** GILLIAN SQUILLACIOTI LCMHC (PSYCHOTHERAPIST)
- **Authorized official phone:** (704) 755-5213

## Contact information

- **Practice address:** 1566 UNION RD, GASTONIA, NC 28054-5301
- **Practice address phone:** (704) 755-5213
- **Mailing address:** 5132 NEWPORT LANDING WAY, GASTONIA, NC 28056-8521
- **Mailing address phone:** (631) 974-9403

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 06/21/2020
- **Last updated:** 06/21/2020