EAST ALABAMA CENTER FOR CHANGE, LLC (NPI# 1902280126) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902280126 |
| Entity Type | Organization |
| Organization Name | EAST ALABAMA CENTER FOR CHANGE, LLC |
| Practice Address |
124 Bragg Ave Auburn AL 36830-3809 |
| Practice Telephone | 3347342603 |
| Practice Fax Number | 3348870031 |
| Mailing Telephone | 3347342603 |
| Mailing Fax Number | 3348870031 |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2015-07-17 |
| Authorized Official Name | AMBER ELIZABETH DOUGLAS (LICENSED PSYCHOLOGIST) |
| Authorized Official Telephone | 3347342603 |
| Authorized Official Credential | PSYD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TH0004X |
Psychologist Specialization: Health |
AL1749 | AL | Behavioral Health & Social Service Providers |
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
AL1749 | AL | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | MEDICARE PTAN | 102I626774 | 01 |
| Street Address |
124 BRAGG AVE |
| City | AUBURN |
| State | AL |
| Zip Code | 36830-3809 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114294261 | Deborah M Breckenridge | Counselor | 124 Bragg Ave, Auburn, AL 36830-3809 | 2011-11-17 |
| 1235562653 | Julia Cleone Brock | Counselor | 124 Bragg Ave, Auburn, AL 36830-3809 | 2013-08-21 |
| 1659625986 | Amber Elizabeth Douglas | Psychologist | 124 Bragg Ave, Auburn, AL 36830 | 2012-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366072878 | Jayson Patrick Hairston | Student in an Organized Health Care Education/Training Program | 1188 Opelika Rd Building 700 Unit 1, Auburn, AL 36830 | 2020-01-23 |
| 1477106417 | Dunn Psychological Services, LLC | Clinic/Center | 2204 Ogletree Village Lane, Suite B, Auburn, AL 36830 | 2019-07-18 |
| 1487117982 | East Alabama Apothecary LLC | Pharmacy | 665 Opelika Roade, Suite 400, Auburn, AL 36830 | 2019-04-11 |
| 1558822759 | Shelley Orthodontics LLC | Dentist | 1957 E. Samford Ave., Ste A, Auburn, AL 36830 | 2019-03-29 |
| 1811454903 | Auburn Pharmacy | Pharmacy | 643 North Dean Road, Auburn, AL 36830 | 2019-02-25 |
| 1386121473 | Joshua D Mathis Dds LLC | Clinic/Center | 2311 Bent Creek Rd., Ste 500, Auburn, AL 36830 | 2018-07-23 |
| 1790213866 | Amy Morton Dean | Pharmacist | 717 Queens, Auburn, AL 36830 | 2017-06-01 |
| 1629519558 | Laura Walton Bell | Nurse Practitioner | 1702 Catherine Ct, Auburn, AL 36830 | 2017-03-11 |
| 1952857229 | North Dean Dental, P.C. | Clinic/Center | 867 North Dean Road, Auburn, AL 36830 | 2016-08-28 |
| 1871960302 | Beverly Harrison Doyle | Physical Therapist | 2515 E. Glenn Ave., Ste 104, Auburn, AL 36830 | 2015-09-01 |
| Find all providers in zip 36830 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922539543 | Nadia Bhuiyan | Psychologist | 101 Cary Hall, Auburn University, Auburn, AL 36849 | 2017-03-24 |
| 1073904231 | Bunny Stanfield | Psychologist | 6435 Fairway Ct., Auburn, CA 95602 | 2015-02-10 |
| 1689097842 | Sierra Hills Individual & Family Therapy | Psychologist | 1230 High St Ste 211, Auburn, CA 95603-5044 | 2014-01-23 |
| 1023354990 | Jennings B. Haynes | Psychologist | 2431 E Glenn Ave Ste 400, Auburn, AL 36830-6419 | 2012-12-21 |
| 1942567136 | Monique Ann Vorous | Psychologist | 381-a Nevada Street, Auburn, CA 95603 | 2012-04-12 |
| 1215249339 | Jennifer Gillis Mattson | Psychologist | 1897 Quail Holw, Auburn, AL 36830-2544 | 2010-07-06 |
| 1316181811 | Richard Edward Mattson | Psychologist | 226 Thach Ave, Thach Hall, Auburn, AL 36849-0001 | 2009-04-28 |
| 1255573267 | Christopher John Correia | Psychologist | 226 Thach Hl, Auburn University Department of Psychology, Auburn, AL 36849-0001 | 2009-04-06 |
| 1881716603 | David Waller | Psychologist | 105 M St Ne, Auburn, WA 98002-4430 | 2007-04-04 |
| 1447372909 | Kristen Maria O'shea | Psychologist | 160 Cherry Ave, Auburn, CA 95603-4812 | 2007-04-04 |
| Find all providers in AUBURN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.