Provider Demographics
NPI:1255633582
Name:TOGETHER LIVES CHANGE
Entity type:Organization
Organization Name:TOGETHER LIVES CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:757-955-5479
Mailing Address - Street 1:2115 EXECUTIVE DR
Mailing Address - Street 2:BUILDING 10-D
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2499
Mailing Address - Country:US
Mailing Address - Phone:757-325-8452
Mailing Address - Fax:757-224-1156
Practice Address - Street 1:2115 EXECUTIVE DR
Practice Address - Street 2:BUILDING 10-D
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2499
Practice Address - Country:US
Practice Address - Phone:757-325-8452
Practice Address - Fax:757-224-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1701251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health