Healthcare Provider Details

I. General information

NPI: 1861085425
Provider Name (Legal Business Name): CAPITAL CREATIVE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 N ORANGE AVE APT 5211
ORLANDO FL
32801-7322
US

IV. Provider business mailing address

776 N ORANGE AVE APT 5211
ORLANDO FL
32801-7322
US

V. Phone/Fax

Practice location:
  • Phone: 407-914-9881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER VILCA
Title or Position: MUSIC THERAPIST
Credential: MT-BC
Phone: 407-914-9881