Organization
INTENTIONAL CHANGE THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATANYA PERDUE LISW (MENTAL HEALTH THERAPIST)
(412) 657-5513
Entity
Organization
Contact information
Practice address
2233 E. 81ST ST., CLEVELAND, OH 44103-5003
(412) 657-5513
Mailing address
P.O. BOX 603249, CLEVELAND, OH 44103-0249
(412) 657-5513
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
06/27/2024
Last updated
06/27/2024
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