| A Center 4 Change | |
|
5900 Route Us 60 W Suite A Ashland KY 41102-9508 | |
| (606) 928-5116 | |
| Not Available |
| Full Name | A Center 4 Change |
|---|---|
| Speciality | Psychologist |
| Location | 5900 Route Us 60 W, Ashland, Kentucky |
| Authorized Official Name and Position | Tonya Michelle Bond Judd (PRESIDENT) |
| Authorized Official Contact | 6069398756 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Center 4 Change Po Box 5074 Ashland KY 41105-5074 Ph: (606) 928-5116 | A Center 4 Change 5900 Route Us 60 W Suite A Ashland KY 41102-9508 Ph: (606) 928-5116 |
| NPI Number | 1639707839 |
|---|---|
| Provider Enumeration Date | 04/01/2020 |
| Last Update Date | 06/29/2020 |
| Certification Date | 06/29/2020 |
| Medicare PECOS PAC ID | 5395167225 |
|---|---|
| Medicare Enrollment ID | O20200623002901 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639707839 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
| Provider Name | Ronald Chevine Fleming |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043431406 PECOS PAC ID: 7719928571 Enrollment ID: I20080602000908 |
| Provider Name | Anna G Labarbera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982805545 PECOS PAC ID: 9032366026 Enrollment ID: I20131209001732 |
| Provider Name | Philip Bloomer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265864425 PECOS PAC ID: 4486947033 Enrollment ID: I20160720001281 |
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