Healthcare Provider Details

I. General information

NPI: 1912603861
Provider Name (Legal Business Name): CREATIVE JOY COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MOUNT AUBURN ST
WATERTOWN MA
02472-3992
US

IV. Provider business mailing address

3642 PAWTUCKET AVE
RIVERSIDE RI
02915-4324
US

V. Phone/Fax

Practice location:
  • Phone: 225-572-1460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State

VIII. Authorized Official

Name: RACHEL AYLSWORTH
Title or Position: OWNER/OPERATOR
Credential: LMHC, BC-DMT
Phone: 225-572-1460