Healthcare Provider Details

I. General information

NPI: 1275676967
Provider Name (Legal Business Name): CREATIVE THERAPY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10339 DEMOCRACY LN
FAIRFAX VA
22030
US

IV. Provider business mailing address

10339A DEMOCRACY LN
FAIRFAX VA
22030
US

V. Phone/Fax

Practice location:
  • Phone: 703-591-3377
  • Fax: 703-591-1359
Mailing address:
  • Phone: 703-591-3377
  • Fax: 703-591-1359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE R WARD
Title or Position: CO-OWNER, OPERATOR
Credential: LPC, LMFT
Phone: 703-591-3377