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General NPI Number Information
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NPI Number | 1306401906
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Entity Type | Organization
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Legal Business Name | CREATIVECOUNSELING LIVING & WELLNESS, LLC
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 1964 HOWELL BRANCH RD STE 110
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City | WINTER PARK
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State | FL
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Zip | 32792-1042
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Country | US
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Telephone | 407-951-4207
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Fax | 321-348-2861
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Provider Business Mailing Address
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Address Line | 877 W MINNEOLA AVE UNIT 120946
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City | CLERMONT
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State | FL
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Zip | 34712-7039
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Country | US
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Telephone | 407-951-4207
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Fax | 321-348-2861
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Authorized Official
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Title or Position | FOUNDER & CEO
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Name | DOMINIQUE MICHELLE BATTLE
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Credential | M.S., NCC, CFT
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Telephone | 407-951-4207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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