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General NPI Number Information
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NPI Number | 1114469657
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Entity Type | Organization
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Legal Business Name | CREATIVE THERAPY AND EDUCATION
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Dates
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Enumeration Date | 11/15/2016
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Last Update Date | 11/15/2016
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Provider Practice Location Address
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Address Line | 298 PARK RD STE 5
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City | WEST HARTFORD
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State | CT
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Zip | 06119-2018
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Country | US
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Telephone | 860-888-7040
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Fax |
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Provider Business Mailing Address
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Address Line | 298 PARK RD STE 5
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City | WEST HARTFORD
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State | CT
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Zip | 06119-2018
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Country | US
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Telephone | 860-888-7040
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Fax |
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Authorized Official
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Title or Position | PROFESSIONAL COUNSELOR
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Name | MS. HANNAH D JACKSON
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Credential | LPC
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Telephone | 860-888-7040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3048
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License Number State | CT
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