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General NPI Number Information
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NPI Number | 1508294059
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Entity Type | Organization
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Legal Business Name | CREATIVE CARE 2
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Dates
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Enumeration Date | 10/18/2013
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Last Update Date | 10/18/2013
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Provider Practice Location Address
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Address Line | 6405 MIDDLEBELT RD
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City | ROMULUS
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State | MI
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Zip | 48174-2036
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Country | US
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Telephone | 734-895-6505
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Fax |
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Provider Business Mailing Address
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Address Line | 6405 MIDDLEBELT RD
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City | ROMULUS
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State | MI
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Zip | 48174-2036
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Country | US
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Telephone | 734-895-6505
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. DEVAN CLARK
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Credential |
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Telephone | 313-713-1018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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