Healthcare Provider Details

I. General information

NPI: 1073455903
Provider Name (Legal Business Name): CREATIVE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 ROBIN LN UNIT 2
CAMERON PARK CA
95682-6402
US

IV. Provider business mailing address

3430 ROBIN LN UNIT 2
CAMERON PARK CA
95682-6402
US

V. Phone/Fax

Practice location:
  • Phone: 530-227-6495
  • Fax:
Mailing address:
  • Phone: 530-227-6495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA CLARK
Title or Position: OWNER
Credential:
Phone: 530-227-6495