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Organization

CHANGE INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DERRICK CHRISTOPHER GIBBS JR. (PRESIDENT / C.E.O.)
(860) 346-0771
Entity
Organization

Contact information

Practice address
1251 S MAIN ST, MIDDLETOWN, CT 06457-5050
(860) 346-0771
(860) 346-0772
Mailing address
1251 S MAIN ST, MIDDLETOWN, CT 06457-5050
(860) 346-0771
(860) 346-0772

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
CT
1041C0700X
Clinical Social Worker
CT
251B00000X
Case Management Agency
Primary
CT
305R00000X
Preferred Provider Organization

Other

Enumeration date
04/10/2012
Last updated
05/13/2015
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