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General NPI Number Information
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NPI Number | 1720317324
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Entity Type | Organization
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Legal Business Name | CREATIVE THERAPIES, INC.
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 12/10/2009
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Provider Practice Location Address
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Address Line | 430 ALBERT ST
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City | BISHOPVILLE
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State | SC
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Zip | 29010-1202
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Country | US
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Telephone | 443-857-1248
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 282 430 N. ALBERT STREET
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City | BISHOPVILLE
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State | SC
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Zip | 29010-0282
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Country | US
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Telephone | 443-857-1248
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MS. GWENDOLYN SHORTER
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Credential |
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Telephone | 443-857-1248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 9089
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License Number State | SC
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