Healthcare Provider Details

I. General information

NPI: 1952115131
Provider Name (Legal Business Name): CREATIVE KIND ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9121 ANSON WAY STE 200
RALEIGH NC
27615-5857
US

IV. Provider business mailing address

9121 ANSON WAY STE 200
RALEIGH NC
27615-5857
US

V. Phone/Fax

Practice location:
  • Phone: 303-954-9446
  • Fax:
Mailing address:
  • Phone: 303-954-9446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DANIEL GUGLIELMO
Title or Position: ADMINISTRATOR
Credential:
Phone: 303-954-9446