Organization
MODERN CHANGE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONIQUE PORTER LCMHC, LCAS (OWNER)
(919) 576-0084
Entity
Organization
Contact information
Practice address
5720 FAYETTEVILLE RD STE 202, DURHAM, NC 27713-5333
(919) 576-0084
(919) 797-9922
Mailing address
5720 FAYETTEVILLE RD STE 202, DURHAM, NC 27713-5333
(919) 576-0084
(919) 797-9922
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1295187763
NPI
—
Enumeration date
03/16/2020
Last updated
04/18/2024
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