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General NPI Number Information
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NPI Number | 1558608158
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Entity Type | Organization
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Legal Business Name | CREATIVE COUNSELING AND CONSULTATIVE SERVICES
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Dates
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Enumeration Date | 01/16/2013
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 2423 LAMB AVE
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City | RICHMOND
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State | VA
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Zip | 23222-4419
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Country | US
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Telephone | 804-525-4101
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Fax | 804-525-4102
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Provider Business Mailing Address
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Address Line | 2423 LAMB AVE
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City | RICHMOND
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State | VA
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Zip | 23222-4419
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Country | US
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Telephone | 804-525-4101
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Fax | 804-525-4102
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Authorized Official
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Title or Position | OWNER
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Name | KATERESEA L FORD
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Credential | PHD
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Telephone | 804-525-4101
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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 | 0701005286
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License Number State | VA
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