=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710130430
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CREATIVE COUNSELING ASSOCIATES, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2008
-----------------------------------------------------
Last Update Date | 10/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 E PIKE ST SUITE LLA
-----------------------------------------------------
City | CANONSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15317-1366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-873-1220
-----------------------------------------------------
Fax | 412-276-5195
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 E PIKE ST SUITE LLA
-----------------------------------------------------
City | CANONSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15317-1366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-873-1220
-----------------------------------------------------
Fax | 412-276-5195
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MS. CAROL A. MILLER-WEINER
-----------------------------------------------------
Credential | M.S.W., L.S.W.
-----------------------------------------------------
Telephone | 724-873-1220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW009543L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------