Healthcare Provider Details

I. General information

NPI: 1184413064
Provider Name (Legal Business Name): C & Z CREATIVE ZEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 WALNUT AVE
COLONIAL HEIGHTS VA
23834-2835
US

IV. Provider business mailing address

7410 HULL STREET RD STE 200
NORTH CHESTERFIELD VA
23235-5834
US

V. Phone/Fax

Practice location:
  • Phone: 804-601-8553
  • Fax: 804-979-0373
Mailing address:
  • Phone: 804-601-8553
  • Fax: 804-979-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CANDICE SHIN
Title or Position: CLINICAL DIRECTOR, OWNER
Credential: LCSW
Phone: 804-601-8553