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General NPI Number Information
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NPI Number | 1245779685
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Entity Type | Organization
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Legal Business Name | CREATIVELY, LLC
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Dates
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Enumeration Date | 02/17/2017
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Last Update Date | 02/17/2017
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Provider Practice Location Address
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Address Line | 5570 STERRETT PL STE 100
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City | COLUMBIA
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State | MD
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Zip | 21044-2641
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Country | US
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Telephone | 443-741-2294
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Fax |
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Provider Business Mailing Address
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Address Line | 9379 RUSTLING LEAF
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City | COLUMBIA
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State | MD
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Zip | 21045-5212
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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 | SOLE PROPRIETOR
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Name | CYNTHIA CISNEROS
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Credential | LCPC
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Telephone | 443-741-2294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 701006308
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LC4473
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License Number State | MD
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