Organization
CHANGING PATHS NC II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUZAN TEAGUE (OWNER)
(910) 631-1036
Entity
Organization
Contact information
Practice address
205 MARTHA LN, CLINTON, NC 28328-9639
(910) 631-1036
Mailing address
205 MARTHA LANE, CLINTON, NC 28328-9639
(175) 789-7568
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
261QM2800X
Methadone Clinic
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
01/18/2023
Last updated
05/02/2023
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