Organization
COLLABORATIVE CHANGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BABE BLACK LCSW (OWNER)
(317) 225-9483
Entity
Organization
Contact information
Practice address
1060 E MAIN ST # S401, BROWNSBURG, IN 46112-1408
(317) 296-4187
(317) 203-0995
Mailing address
8331 CRAWFORDSVILLE RD, INDIANAPOLIS, IN 46234-7740
(317) 296-4187
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34005850A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20119194A
—
IN
Enumeration date
08/15/2013
Last updated
05/04/2022
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