Healthcare Provider Details

I. General information

NPI: 1871969600
Provider Name (Legal Business Name): CREATIVE COUNSELING CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2015
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 KENNEDY LANE
CONCORD NH
03301
US

IV. Provider business mailing address

18 KENNEDY LANE
CONCORD NH
03301
US

V. Phone/Fax

Practice location:
  • Phone: 603-708-1438
  • Fax: 888-287-5926
Mailing address:
  • Phone: 603-708-1438
  • Fax: 888-287-5926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number997
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number997
License Number StateNH

VIII. Authorized Official

Name: MRS. CHELSEA MARIE BEGIN
Title or Position: CLINICIAN, MEMBER
Credential: LCMHC
Phone: 603-708-1438