MEDICARE: CREATIVE SISTERS COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1194349795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE SISTERS COUNSELING LLC

Provider Business Mailing Address
First Line	:	134 FAIRMONT ST STE C
Second Line	:
City	:	CLINTON
State	:	MS
Zip	:	39056-4739
Country	:	US
Telephone Number	:	601-913-9800
Fax Number	:	769-447-4943

Provider Business Practice Location Address
First Line	:	134 FAIRMONT ST STE C
Second Line	:
City	:	CLINTON
State	:	MS
Zip	:	39056-4739
Country	:	US
Telephone Number	:	601-913-9800
Fax Number	:	769-447-4943

Authorized Official
Title or Position	:	OWNER
Name	:	LASHONNA DENISE FLETCHER
Credential	:	LPC
Telephone Number	:	601-913-9800

Provider Enumeration Date	:	05/31/2020
Last Update Date	:	05/31/2020

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