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General NPI Number Information
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NPI Number | 1689239899
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Entity Type | Organization
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Legal Business Name | CREATIVE COUNSELING PLLC
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 205 E DAVIS ST
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City | BURLINGTON
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State | NC
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Zip | 27215-5987
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Country | US
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Telephone | 919-358-8570
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Fax |
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Provider Business Mailing Address
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Address Line | 615 BUNKER DR
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City | MEBANE
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State | NC
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Zip | 27302-9819
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Country | US
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Telephone | 919-358-8570
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMILA CHAYA FREEMAN
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Credential |
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Telephone | 919-358-8570
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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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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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