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General NPI Number Information
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NPI Number | 1174384812
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Entity Type | Organization
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Legal Business Name | CREATIVE CARE COUNSELING, LLC
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Dates
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Enumeration Date | 01/19/2024
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 802 CUSTER AVE STE B
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City | NORFOLK
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State | NE
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Zip | 68701-0859
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Country | US
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Telephone | 402-230-7576
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Fax |
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Provider Business Mailing Address
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Address Line | 710 S. 13TH ST. STE 900 PMB 216
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City | NORFOLK
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State | NE
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Zip | 68701-5792
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Country | US
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Telephone | 402-230-7576
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Fax | 402-226-4824
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Authorized Official
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Title or Position | PROVIDER
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Name | MARIAH HERGOTT
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Credential |
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Telephone | 402-230-7576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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