Healthcare Provider Details

I. General information

NPI: 1386788461
Provider Name (Legal Business Name): CENTER FOR CREATIVE COLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10641 ARISTOCRAT CT
SANTEE CA
92071-1216
US

IV. Provider business mailing address

10641 ARISTOCRAT CT
SANTEE CA
92071-1216
US

V. Phone/Fax

Practice location:
  • Phone: 619-549-2963
  • Fax: 951-245-0309
Mailing address:
  • Phone: 619-549-2963
  • Fax: 951-245-0309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS17752
License Number StateCA

VIII. Authorized Official

Name: MR. DAVID SQUIRE
Title or Position: SOCIAL WORKER
Credential: LCSW
Phone: 619-334-0005