Organization
LIVING CHANGE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROL COULTHURST (CEO)
(678) 570-0880
Entity
Organization
Contact information
Practice address
301 CASTEEL RD SW, MARIETTA, GA 30064-1611
(678) 570-0880
(678) 290-2850
Mailing address
301 CASTEEL RD SW, MARIETTA, GA 30064-1611
(678) 570-0880
(678) 290-2850
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
CLA005765
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
587942289A
—
GA
Enumeration date
08/23/2018
Last updated
08/23/2018
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