CHANGING PHASES BEHAVIORAL SUPPORT, INC - NPI 1497094205 - Community/Behavioral Health in Marietta, GA

Q: What is Changing Phases Behavioral Support, Inc's specialty?

The primary specialty registered for this NPI is Community/Behavioral Health with taxonomy code 251S00000X.

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About Changing Phases Behavioral Support, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CHANGING PHASES BEHAVIORAL SUPPORT, INC (NPI 1497094205) is a healthcare organization registered as a community/behavioral health in Marietta, Georgia and active in the NPI registry since February 2013. The organization holds a CLIA Waiver certificate valid through August 11, 2027 and lists Mya S Cullins, Vice President, as its authorized official.

NPPES Registry Identity

NPI1497094205

Entity TypeOrganization

Primary Taxonomy251S00000X

Legal Business NameCHANGING PHASES BEHAVIORAL SUPPORT, INC

Location Address3655 CANTON RD STE 201Marietta, GA 30066

Mailing Address3655 Canton RdMarietta, GA 30066-2690 · (770) 726-1162 · Fax (770) 702-5966

Phone(707) 261-1627

Fax(707) 702-5966

Organization SubpartNo

Authorized OfficialMya S CullinsVice President · (336) 268-6469

Enumeration DateFebruary 14, 2013

Last NPPES UpdateAugust 17, 20182 updates tracked since enumeration

✔ NPI 1497094205 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCommunity/Behavioral HealthAgencies

Taxonomy Code251S00000X

Definition

A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

Also ListedInternal MedicineTaxonomy 207R00000X · License 25937 (GA)

3655 CANTON RD STE 201, Marietta, GA 30066

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2100302

Changing Phases · Marietta, GA

Active · expires Aug 11, 2027

CLIA Number11D2100302

Laboratory TypeBh Agency

Certificate Effective DateAugust 12, 2025

Certificate Expiration DateAugust 11, 2027

Laboratory DirectorMya S. Cullins

Laboratory Phone(678) 903-5197

Laboratory LocationChanging Phases3655 Canton Road, Suite 201, Marietta, GA 30066

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GINA MARIE WILLIAMS CADCII

Counselor (Addiction (Substance Use Disorder))