Change Academy At Lake Of The Ozarks
Clinic/Center, Mental Health (Including Community Mental Health Center) in Ashburn, VA. Organization (NPI-2).
NPI number1568188340
StatusActive
Last updated in NPPESMay 21, 2025
Details
- NPI
- 1568188340
- Entity type
- Organization (NPI-2)
- Legal business name
- Change Academy At Lake Of The Ozarks
- Organization subpart
- Yes
- Enumeration date
- Oct 13, 2022
- Certification date
- May 21, 2025
- Last updated
- May 21, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
Other names
- Embark Virtual At Virginia (Other Name)
Practice location
20116 Ashbrook Pl Ste 110Ashburn, VA 20147-5086
Phone 480-550-9281
Mailing address
5500 Ming Ave Ste 410Bakersfield, CA 93309-4631
Phone 661-622-4132
Authorized official
Sharnell Spencer
Credentialing Manager
6612396923
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