Changing Phases Behavioral Support, Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

CHANGING PHASES BEHAVIORAL SUPPORT, INC

Practice address

3655 Canton Rd Ste 201
Marietta, GA 30066

Phone

(707) 261-1627

Fax

(707) 702-5966

NPI assigned

Feb 14, 2013

Organization subpart

No

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

Authorized official

Name

Mrs. Mya S Cullins, LCASANPI 1790038685

Title

Vice President

Phone

(336) 268-6469

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Austin, M.D.

  • Internal Medicine Physician
  • Snellville, GA
  • NPI 1134155153
  Medicare reassignment NPD
• Miles Johnson, M.D.

  • Family Medicine Physician
  • Fayetteville, GA
  • NPI 1568419844
  Medicare reassignment NPD
• Mya S Cullins, MS, LCASA

  • Mental Health Counselor
  • Greensboro, NC
  • NPI 1790038685
  NPD Authorized official
• Mallory Cary

  • Clinical Social Worker
  • Scottdale, GA
  • NPI 1801380100
  NPD (past)
• Precious Fuflay Dixon, BSW, MA, ST

  • Professional Counselor
  • Marietta, GA
  • NPI 1134584980
  NPD (past)
• Delacia Gail, CADCII

  • Addiction (Substance Use Disorder) Counselor
  • Marietta, GA
  • NPI 1457840852
  NPD (past)
• Shanithia Kendrick, LPC

  • Counselor
  • Fayetteville, GA
  • NPI 1346740222
  NPD (past)
• Ouida Lyons, M.S.

  • Community/Behavioral Health Agency
  • Marietta, GA
  • NPI 1912351586
  NPD (past)
• Kimberly McFadden

  • Licensed Practical Nurse
  • Marietta, GA
  • NPI 1396234712
  NPD (past)
• Courtney Brooke Pollard, R.N.

  • Registered Nurse
  • Marietta, GA
  • NPI 1811442726
  NPD (past)
• Debra Karen Priesmeyer, RN

  • Psychiatric/Mental Health Registered Nurse
  • Marietta, GA
  • NPI 1487014031
  NPD (past)
• Errick Thornton

  • Addiction (Substance Use Disorder) Counselor
  • Marietta, GA
  • NPI 1639668957
  NPD (past)

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

{
    "created_epoch": "1360800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534464000000",
    "number": "1497094205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3655 CANTON RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300662690",
            "telephone_number": "770-726-1162",
            "fax_number": "770-702-5966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3655 CANTON RD STE 201",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30066",
            "telephone_number": "707-261-1627",
            "fax_number": "707-702-5966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGING PHASES BEHAVIORAL SUPPORT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-14",
        "last_updated": "2018-08-17",
        "status": "A",
        "authorized_official_last_name": "CULLINS",
        "authorized_official_first_name": "MYA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "336-268-6469",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCASA"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "25937",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Johnny Brent Chandler
• Kristina Elizabeth Chandler, DMD
• Laurie A Chandler, LAPC
• Bryan Chang, MD
• Steven Chang, DC
• Samantha Lee Chaparro, PA-C
• Kevin Chapla, M.D.
• Maurice Harold Chapman III
• Rodger W Chapman, MD
• Mary Lanham Chappell, M.D.

• Community/Behavioral Health Agency in Marietta, GA
• Providers in Marietta, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.