11D2100302 CLIA NUMBER - CHANGING PHASES

Laboratory Demographics

  • CLIA Code: 11D2100302
  • Facility Name: CHANGING PHASES
  • Facility Address: 3655 CANTON ROAD, SUITE 201
    MARIETTA, GA
    ZIP 30066
  • Facility Phone: 678 903-5197
  • Facility Type: Other - BH AGENCY
  • Facility Type: Waiver
  • Lab Director: MYA S. CULLINS
  • NPI Number: 1497094205
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 11D2100302
LAB Type Other - BH AGENCY
Facility Name CHANGING PHASES
Street 3655 CANTON ROAD, SUITE 201
City MARIETTA
State GA
ZIP 30066
Phone 678 903-5197
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/12/2025
Certificate Expiration Date 8/11/2027
Facility Type Other - BH AGENCY
Lab Director MYA S. CULLINS

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This page was last updated on: 9/29/2025