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General NPI Number Information
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NPI Number | 1508437179
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Entity Type | Organization
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Legal Business Name | CREATIVE CHANGE COUNSELING, INC.
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Dates
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Enumeration Date | 07/06/2021
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 322 E 5TH ST
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City | LAKEWOOD
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State | NJ
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Zip | 08701-3415
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Country | US
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Telephone | 609-668-4719
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Fax | 609-667-7944
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Provider Business Mailing Address
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Address Line | 668 MAIN ST
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City | LUMBERTON
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State | NJ
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Zip | 08048-5016
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Country | US
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Telephone | 609-668-4719
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Fax | 609-667-7944
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Authorized Official
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Title or Position | CEO
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Name | BERTEE THOMAS
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Credential | PSY. D., LPC
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Telephone | 609-667-7353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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