Organization
A CHANCE FOR CHANGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMANDA COLEMON BA, PSYCHOLOGY, QMHP (CHIEF EXECUTIVE OFFICER)
(980) 745-9867
Entity
Organization
Contact information
Practice address
999 WATERSIDE DR STE 2525, NORFOLK, VA 23510-3316
(757) 777-3454
(757) 568-7437
Mailing address
999 WATERSIDE DR STE 2525, NORFOLK, VA 23510-3316
(757) 777-3454
(757) 568-7437
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
—
—
225C00000X
Rehabilitation Counselor
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
—
405300000X
Prevention Professional
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417573189
—
VA
05
—
1427603182
—
VA
05
—
1609289479
—
VA
Enumeration date
02/10/2020
Last updated
08/03/2020
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