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General NPI Number Information
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NPI Number | 1558177659
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Entity Type | Organization
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Legal Business Name | CREATIVE OPPORTUNITIES FOR PERSONAL EMPOWERMENT, LLC
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 455 CONCORD PKWY N UNIT 5649
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City | CONCORD
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State | NC
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Zip | 28027-6749
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Country | US
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Telephone | 704-247-7111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5649
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City | CONCORD
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State | NC
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Zip | 28027-1510
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Country | US
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Telephone | 704-247-7111
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Fax |
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | MRS. TIFFANY GRAHAM
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Credential | MA, LCMHC, LCASA
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Telephone | 704-247-7111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health 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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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