Organization
CHANGING LANES INTERVENTION HUMAN SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY MARTIN LPC,LBA,BCBA,CRPS (CHIEF EXECUTIVE OFFICER)
(770) 580-4116
Entity
Organization
Contact information
Practice address
500 LANIER AVE W STE 608, FAYETTEVILLE, GA 30214-7644
(770) 580-4116
(888) 522-1055
Mailing address
500 LANIER AVE W STE 608, FAYETTEVILLE, GA 30214-7644
(770) 256-3977
(888) 522-1055
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
103K00000X
Behavior Analyst
—
—
103T00000X
Psychologist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
05/27/2022
Last updated
04/12/2024
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