Changeworks Psychotherapy & Life Coaching Services, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904004708 Issued in VA

Legal business name

CHANGEWORKS PSYCHOTHERAPY & LIFE COACHING SERVICES, LLC

Practice address

9218 Centreville Rd
Manassas, VA 20110-5131

Phone

(703) 626-0381

NPI assigned

May 18, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Maureen Fannin, LCSW

Title

President

Phone

(703) 626-0381

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196035200000",
    "number": "1326091844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9218 CENTREVILLE RD",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201105131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9218 CENTREVILLE RD",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201105131",
            "telephone_number": "703-626-0381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGEWORKS PSYCHOTHERAPY & LIFE COACHING SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2007-11-26",
        "status": "A",
        "authorized_official_last_name": "FANNIN",
        "authorized_official_first_name": "MAUREEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-626-0381",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904004708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10141788",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Avtar S Chana, M.D
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• Philip Chang, DMD
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• Kathryn Chase, PHARMD
• Ivania Chavarria-Montero, LMT
• Paige Chavez
• Chebli Health Care LLC

• Clinical Social Worker in Manassas, VA
• Providers in Manassas, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.