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General NPI Number Information
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NPI Number | 1497316715
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Entity Type | Organization
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Legal Business Name | CENTER FOR CREATIVE VALUES
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 515 E JOPPA RD STE 100
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City | BALTIMORE
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State | MD
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Zip | 21286-1804
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Country | US
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Telephone | 410-337-0938
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Fax |
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Provider Business Mailing Address
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Address Line | 515 E JOPPA RD STE 100
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City | BALTIMORE
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State | MD
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Zip | 21286-1804
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Country | US
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Telephone | 410-337-0938
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR / CEO
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Name | KAY ATOLOYE
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Credential |
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Telephone | 443-929-8315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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