Healthcare Provider Details

I. General information

NPI: 1265041263
Provider Name (Legal Business Name): CREATIVE CONNECTION COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 NW MARINE AVE
LINCOLN CITY OR
97367-4660
US

IV. Provider business mailing address

3125 NW MARINE AVE
LINCOLN CITY OR
97367-4660
US

V. Phone/Fax

Practice location:
  • Phone: 970-773-7133
  • Fax:
Mailing address:
  • Phone: 970-210-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: CARRIE LEBLANC
Title or Position: OWNER
Credential: LPC
Phone: 970-210-7217