Healthcare Provider Details

I. General information

NPI: 1083324743
Provider Name (Legal Business Name): CREATIVE COUNSELING AND CONSULTING OF ALABAMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8975 CROSSWIND CIR APT 205
MONTGOMERY AL
36117-8081
US

IV. Provider business mailing address

8975 CROSSWIND CIR APT 205
MONTGOMERY AL
36117-8081
US

V. Phone/Fax

Practice location:
  • Phone: 334-322-6964
  • Fax:
Mailing address:
  • Phone: 334-322-6964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RONNIE LAMONT PORCHIA
Title or Position: OWNER
Credential: LPC-S
Phone: 334-322-6964