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General NPI Number Information
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NPI Number | 1043377278
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Entity Type | Organization
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Legal Business Name | CREATIVE LIVING ASSOCIATES
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 101 VANCE AVE
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City | KANNAPOLIS
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State | NC
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Zip | 28081-4339
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Country | US
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Telephone | 704-788-9184
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 E WT HARRIS BLVD SUITE P-317
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City | CHARLOTTE
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State | NC
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Zip | 28213-4104
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SENIOR ASSOCIATE
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Name | DR. GLEN REDIEHS
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Credential | PH.D.
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Telephone | 704-788-9184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 526
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2296
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License Number State | NC
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