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General NPI Number Information
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NPI Number | 1710498209
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Entity Type | Organization
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Legal Business Name | TINKER CREEK CREATIVE COUNSELING, LLC
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Dates
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Enumeration Date | 10/24/2017
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 8245 WILLIAMSON RD
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City | ROANOKE
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State | VA
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Zip | 24019-6951
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Country | US
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Telephone | 540-293-7601
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Fax |
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Provider Business Mailing Address
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Address Line | 4754 MEADOW CROSSING LN NE
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City | ROANOKE
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State | VA
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Zip | 24019-5874
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Country | US
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Telephone | 540-293-7601
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Fax |
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Authorized Official
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Title or Position | OWNER/LPC
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Name | MRS. CHRISTIN VAUGHN
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Credential | LPC
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Telephone | 540-293-7601
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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 | VA
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