| Affecting Change, Llc | |
|
22511 Telegraph Rd Ste 128 Southfield MI 48033-4130 | |
| (248) 905-1126 | |
| (313) 209-8989 |
| Full Name | Affecting Change, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 22511 Telegraph Rd Ste 128, Southfield, Michigan |
| Authorized Official Name and Position | Andre D Charley (OWNER) |
| Authorized Official Contact | 3135879869 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Affecting Change, Llc 22511 Telegraph Rd Ste 128 Southfield MI 48033-4130 Ph: (248) 905-1126 | Affecting Change, Llc 22511 Telegraph Rd Ste 128 Southfield MI 48033-4130 Ph: (248) 905-1126 |
| NPI Number | 1699063297 |
|---|---|
| Provider Enumeration Date | 07/16/2011 |
| Last Update Date | 03/21/2022 |
| Certification Date | 03/21/2022 |
| Medicare PECOS PAC ID | 7416325634 |
|---|---|
| Medicare Enrollment ID | O20221119000382 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699063297 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | D25724 (Michigan) | Primary |
| Provider Name | Andre Charley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942570817 PECOS PAC ID: 8325416548 Enrollment ID: I20221119000406 |
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