Changing Lives Therapeutic Service, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

CHANGING LIVES THERAPEUTIC SERVICE, LLC

Doing business as

Changing Lives Therapeutic Service,LLC

Practice address

413 Mount Cross Rd Ste 102
Danville, VA 24540-4089

Phone

(888) 388-8726

NPI assigned

May 14, 2020

Last updated

Mar 24, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Cemetrius Rolle, LCSWNPI 1295117760

Title

Co-Owner

Phone

(980) 833-1121

Specialties & licenses 6

Addresses

Other identifiers 2

Other names 1

• CHANGING LIVES THERAPEUTIC SERVICE,LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Cemetrius Teouna Rolle, MSW, LCSWA

  • Clinical Social Worker
  • Greensboro, NC
  • NPI 1295117760

  VA

  Medicare reassignment NPD Authorized official
• Chassity Paulette Clapp, LCSW-A

  • Clinical Social Worker
  • Charlotte, NC
  • NPI 1871229385
  NPD
• Charnell C Murphy, MAJOR ON MENTHAL HEA

  • Professional Counselor
  • Danville, VA
  • NPI 1154943389
  NPD (past)
• Bernardine Wells

  • Mental Health Counselor
  • Greensboro, NC
  • NPI 1467175125
  NPD (past)

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

{
    "created_epoch": "1589414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742774400000",
    "number": "1891317657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8825 UNIVERSITY EAST DR STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282134395",
            "telephone_number": "980-833-1121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 MOUNT CROSS RD STE 102",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245404089",
            "telephone_number": "888-388-8726"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8825 University East Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282134395",
            "country_code": "US",
            "telephone_number": "980-883-1121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHANGING LIVES THERAPEUTIC SERVICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-14",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A",
        "authorized_official_last_name": "ROLLE",
        "authorized_official_first_name": "CEMETRIUS",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "980-833-1121",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295117760",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922582998",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHANGING LIVES THERAPEUTIC SERVICE,LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHANGING LIVES THERAPEUTIC SERVICE,LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Kristine Chacon, SLP
• Carrington Atkins Chambers, LPC
• Zenise Ronnae Chambers
• Randy Michael Chan, D.O.
• Susan Ann Chandler, LPC
• Patty J Chapell, NURSE PRACTITIONER
• Mackensie Brooke Chapman, PHARMD
• Charlottesville League of Therapists, Inc (Danville League of Therapists)
• Charlottesville League of Therapists, Inc (Danville League of Therapists)
• Shtakshe Chatrath, DO

• Community/Behavioral Health Agency in Danville, VA
• Providers in Danville, VA by specialty
• Community/Behavioral Health Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.