Healthcare Provider Details

I. General information

NPI: 1215393921
Provider Name (Legal Business Name): CREATIVE WELLBEING WORKSHOPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3912 JENIFER ST NW
WASHINGTON DC
20015-1950
US

IV. Provider business mailing address

3912 JENIFER ST NW
WASHINGTON DC
20015-1950
US

V. Phone/Fax

Practice location:
  • Phone: 202-352-5225
  • Fax:
Mailing address:
  • Phone: 202-352-5225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberACT044
License Number StateMD

VIII. Authorized Official

Name: REBECCA ANN WILKINSON
Title or Position: ART THERAPIST
Credential: LCPAT
Phone: 202-352-5225