Organization
CHANGING LIVES THERAPEUTIC SERVICE, LLC
Active
Organization
CHANGING LIVES THERAPEUTIC SERVICE, LLC
Active
Other names
CHANGING LIVES THERAPEUTIC SERVICE,LLC
Organization subpart
No
Provider details
NPI number
Authorized official
CEMETRIUS ROLLE LCSW (CO-OWNER)
(980) 833-1121
Entity
Organization
Contact information
Practice address
413 MOUNT CROSS RD STE 102, DANVILLE, VA 24540-4089
(888) 388-8726
Mailing address
8825 UNIVERSITY EAST DR STE 200, CHARLOTTE, NC 28213-4395
(980) 833-1121
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
175T00000X
Peer Specialist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295117760
—
NC
05
—
1922582998
—
NC
Enumeration date
05/14/2020
Last updated
03/24/2025
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