Organization
CHANGING BY CHOICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ARCELIA MILLER-JACKSON MA, MDIV, LPC, LSATP (CEO)
(804) 495-3000
Entity
Organization
Contact information
Practice address
6001 LAKESIDE AVE STE 23, HENRICO, VA 23228-5748
(804) 495-3000
(804) 495-3003
Mailing address
2510 EDENBROOK DR, HENRICO, VA 23228-3038
(804) 420-5405
(804) 495-3003
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
08/24/2020
Last updated
03/05/2024
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