Organization
THE INITIATIVE FOR CHANGE AND DEVELOPMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN BLACKSHEAR LCDC, CART, COPSD (DIRECTOR)
(832) 964-3849
Entity
Organization
Contact information
Practice address
1146 WILLOW CREEK DR, LA PORTE, TX 77571-2711
(832) 964-3849
Mailing address
1146 WILLOW CREEK DRIVE, LA PORTE, TX 77571
(832) 964-3849
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
11387
TX
Other
Enumeration date
08/18/2014
Last updated
08/18/2014
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