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General NPI Number Information
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NPI Number | 1154382265
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Entity Type | Organization
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Legal Business Name | CREATIVE COUNSELING PA
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 205 WAYMONT CT SUITE 111
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City | LAKE MARY
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State | FL
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Zip | 32746-3593
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Country | US
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Telephone | 407-688-1770
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Fax | 407-688-7205
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Provider Business Mailing Address
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Address Line | 205 WAYMONT COURT SUITE 111
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City | LAKE MARY
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State | FL
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Zip | 32746-3549
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Country | US
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Telephone | 407-688-1770
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Fax | 407-688-7205
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Authorized Official
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Title or Position | PRES
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Name | MICHELLE ANN SALOMON
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Credential | LMHC
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Telephone | 407-688-1770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | MH7317
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License Number State | FL
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