Organization
CHANGING PHASES BEHAVIORAL SUPPORT, INC
Active
Organization
CHANGING PHASES BEHAVIORAL SUPPORT, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MYA S CULLINS LCASA (VICE PRESIDENT)
(336) 268-6469
Entity
Organization
Contact information
Practice address
3655 CANTON RD STE 201, MARIETTA, GA 30066
(707) 261-1627
(707) 702-5966
Mailing address
3655 CANTON RD, MARIETTA, GA 30066-2690
(770) 726-1162
(770) 702-5966
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25937
GA
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/14/2013
Last updated
08/17/2018
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