Provider Demographics
NPI:1174373179
Name:COMMUNITY CHANGE CENTER: WEAREONE, INCORPORATED
Entity type:Organization
Organization Name:COMMUNITY CHANGE CENTER: WEAREONE, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:765-430-8952
Mailing Address - Street 1:7112 VAN BUREN CT
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-3859
Mailing Address - Country:US
Mailing Address - Phone:765-430-8952
Mailing Address - Fax:
Practice Address - Street 1:4444 CONNECTICUT ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46409-2126
Practice Address - Country:US
Practice Address - Phone:219-885-9560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty