Healthcare Provider Details

I. General information

NPI: 1649844499
Provider Name (Legal Business Name): EREN O. MOORE DBA CREATIVE FREEDOM COUNSELING & CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 EVERGREEN AVE
PLAINFIELD NJ
07060-2614
US

IV. Provider business mailing address

12207 S 29TH AVE
BELLEVUE NE
68123-1447
US

V. Phone/Fax

Practice location:
  • Phone: 917-863-3088
  • Fax:
Mailing address:
  • Phone: 908-791-5970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. EREN O. MOORE
Title or Position: FOUNDER/CLINICIAN
Credential: MSW, LCSW
Phone: 908-791-5970