Organization
CENTER FOR CONSCIOUS CHANGE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA NEISLER LCSW (DIRECTOR)
(919) 368-3684
Entity
Organization
Contact information
Practice address
900 COPPERFIELD BLVD NE, CONCORD, NC 28025-2433
(704) 729-4767
Mailing address
1614 PAT GARRETT ST, CHARLOTTE, NC 28206-2187
(919) 368-3684
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C006216
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1689728784
BLUE CROSS BLUE SHIELD
—
05
—
6007170
—
NC
01
—
6007227
AETNA
—
01
—
977827
BEACON HEALTH
—
Enumeration date
05/22/2018
Last updated
05/22/2018
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