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Organization
SUPPORTED CHANGE,LLC
Active
Organization
SUPPORTED CHANGE,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON JOHANSON (OWNER/LCSW)
(720) 507-5023
Entity
Organization
Contact information
Practice address
609 W LITTLETON BLVD SUITE 201, LITTLETON, CO 80120
(720) 507-5023
Mailing address
PO BOX 3414, LITTLETON, CO 80120
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2112
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11070382
—
CO
Enumeration date
05/04/2016
Last updated
08/11/2016
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