Organization · NPI-2

Change Academy At Lake Of The Ozarks

Clinic/Center, Mental Health (Including Community Mental Health Center) · Ashburn, VA

NPI number1760199244
StatusActive
Last updated in NPPESJun 3, 2026

Details

NPI
1760199244
Entity type
Organization (NPI-2)
Legal business name
Change Academy At Lake Of The Ozarks
Organization subpart
Yes
Enumeration date
Nov 3, 2022
Certification date
Jun 3, 2026
Last updated
Jun 3, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––Yes

Other names

  • Embark Behavioral Health (Other Name)
  • Embark Virtual At Virginia (Other Name)

Practice location

20116 Ashbrook Pl Ste 110
Ashburn, VA 20147-5086

Phone 480-660-8757

Mailing address

5500 Ming Ave Ste 410
Bakersfield, CA 93309-4631

Phone 661-622-4132

Authorized official

Sharnell Spencer
Credentialing Manager
6612396923

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

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