Organization
JAKES PLACE FOR CHANGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE LANE MS COUNSELING, LBSW (DIRECTOR/OWNER)
(256) 459-5600
Entity
Organization
Contact information
Practice address
116 CHURCH ST STE 4, RAINBOW CITY, AL 35906-6287
(256) 459-5600
Mailing address
116 CHURCH ST STE 4, RAINBOW CITY, AL 35906-6287
(256) 459-5600
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
—
—
251B00000X
Case Management Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261Q00000X
Clinic/Center
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QF0050X
Non-Surgical Family Planning Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
261QR1100X
Research Clinic/Center
—
—
347C00000X
Private Vehicle
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
03/06/2018
Last updated
03/06/2018
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