Healthcare Provider Details

I. General information

NPI: 1225438773
Provider Name (Legal Business Name): CREATIVE COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 W CHICAGO BLVD SUITE 14
TECUMSEH MI
49286-1666
US

IV. Provider business mailing address

808 W CHICAGO BLVD SUITE 14
TECUMSEH MI
49286-1666
US

V. Phone/Fax

Practice location:
  • Phone: 517-879-5838
  • Fax:
Mailing address:
  • Phone: 517-879-5838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009777
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801092595
License Number StateMI

VIII. Authorized Official

Name: LUANN M SAWDEY-ROBERTS
Title or Position: CO OWNER
Credential:
Phone: 517-879-5838