# CHANGING PHASES BEHAVIORAL SUPPORT

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Changing Phases Behavioral Support One
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811057045
- **Authorized official:** MR. QUINTEN CULLINS (PROGRAM DIRECTOR)
- **Authorized official phone:** (336) 333-2542

## Contact information

- **Practice address:** 1609 CLEMMONS ST, GREENSBORO, NC 27406-2870
- **Practice address phone:** (336) 333-2542
- **Practice address fax:** (336) 333-2858
- **Mailing address:** 338 N ELM ST, SUITE 215, GREENSBORO, NC 27401-2177
- **Mailing address phone:** (336) 333-2542
- **Mailing address fax:** (336) 333-2858

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | — | — | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL-041-794 | NC | Yes |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL-041-894 | NC | — |

## Other

- **Enumeration date:** 12/11/2006
- **Last updated:** 03/12/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6006908 | — | NC |
| 05 | — | 6604413 | — | NC |
| 05 | — | 8301765 | — | NC |
| 05 | — | 8301765G | — | NC |