Healthcare Provider Details

I. General information

NPI: 1134998982
Provider Name (Legal Business Name): CREATING SPACE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10431 PATTERSON AVE
HENRICO VA
23238-5101
US

IV. Provider business mailing address

10431 PATTERSON AVE
HENRICO VA
23238-5101
US

V. Phone/Fax

Practice location:
  • Phone: 202-240-2423
  • Fax:
Mailing address:
  • Phone: 202-240-2423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SONIA CASTRO-CASTILLO
Title or Position: OWNER
Credential: LPC
Phone: 202-240-2423