Healthcare Provider Details

I. General information

NPI: 1881507002
Provider Name (Legal Business Name): CREATING CONNECTION, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 KINNEY RD
APPOMATTOX VA
24522-5594
US

IV. Provider business mailing address

191 KINNEY RD
APPOMATTOX VA
24522-5594
US

V. Phone/Fax

Practice location:
  • Phone: 651-468-4326
  • Fax:
Mailing address:
  • Phone: 651-468-4326
  • 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: JORDAN LEE JOHNSON
Title or Position: OWNER
Credential: LPC
Phone: 651-468-4326