Organization
CHANGEWORKS PSYCHOTHERAPY & LIFE COACHING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAUREEN FANNIN LCSW (PRESIDENT)
(703) 626-0381
Entity
Organization
Contact information
Practice address
9218 CENTREVILLE RD, MANASSAS, VA 20110-5131
(703) 626-0381
Mailing address
9218 CENTREVILLE RD, MANASSAS, VA 20110-5131
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904004708
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10141788
—
VA
Enumeration date
05/18/2006
Last updated
11/26/2007
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