Healthcare Provider Details

I. General information

NPI: 1376262840
Provider Name (Legal Business Name): CREATIVE PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 EXECUTIVE PARK NW STE A
CLEVELAND TN
37312-2770
US

IV. Provider business mailing address

4423 SUSANNA CT
FARMVILLE NC
27828-8530
US

V. Phone/Fax

Practice location:
  • Phone: 540-418-0105
  • Fax: 540-404-2126
Mailing address:
  • Phone: 540-759-0037
  • Fax: 540-404-2126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICOLE MICHELE HOFFMAN MILLER
Title or Position: OWNER/CEO
Credential: PSYD
Phone: 540-759-0037