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General NPI Number Information
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NPI Number | 1003142761
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Entity Type | Organization
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Legal Business Name | CREATIVE CONCEPTS THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 10/29/2009
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | 100 PEAR ST
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City | ABERDEEN
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State | NC
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Zip | 28315-2924
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Country | US
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Telephone | 910-528-6172
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Fax | 910-944-2417
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Provider Business Mailing Address
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Address Line | PO BOX 3594
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City | PINEHURST
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State | NC
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Zip | 28374-3594
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Country | US
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Telephone | 910-528-6172
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Fax | 910-944-2417
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. AESHIA L. JACKSON
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Credential | MSW
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Telephone | 910-528-6172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P004034
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License Number State | NC
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