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General NPI Number Information
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NPI Number | 1437645967
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Entity Type | Organization
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Legal Business Name | CREATIVE COUNSELING LLC
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Dates
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Enumeration Date | 07/09/2018
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Last Update Date | 08/15/2019
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Provider Practice Location Address
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Address Line | 435 BUCKLAND RD. BRANDYWINE
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-3720
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Country | US
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Telephone | 860-268-0305
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Fax |
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Provider Business Mailing Address
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Address Line | 77 MONTAUK DR
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City | VERNON
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State | CT
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Zip | 06066-5305
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Country | US
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Telephone | 860-841-9077
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIELLE CLERE
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Credential | LPC
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Telephone | 860-841-9077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 002689
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License Number State | CT
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