| Positive Change Therapeutic Solutions, Llc | |
|
4410 Claiborne Sq E Ste 334 Hampton VA 23666-2074 | |
| (757) 751-9591 | |
| (757) 720-4180 |
| Full Name | Positive Change Therapeutic Solutions, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4410 Claiborne Sq E Ste 334, Hampton, Virginia |
| Authorized Official Name and Position | Angela N Dickerson (OWNER) |
| Authorized Official Contact | 7577519591 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Positive Change Therapeutic Solutions, Llc 48 Calhoun St Hampton VA 23669-2434 Ph: (757) 751-9591 | Positive Change Therapeutic Solutions, Llc 4410 Claiborne Sq E Ste 334 Hampton VA 23666-2074 Ph: (757) 751-9591 |
| NPI Number | 1417700436 |
|---|---|
| Provider Enumeration Date | 04/09/2024 |
| Last Update Date | 04/09/2024 |
| Certification Date | 04/09/2024 |
| Medicare PECOS PAC ID | 7517305527 |
|---|---|
| Medicare Enrollment ID | O20240409003487 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417700436 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Angela N Dickerson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629515424 PECOS PAC ID: 8224476262 Enrollment ID: I20240409004823 |
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