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General NPI Number Information
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NPI Number | 1720793953
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Entity Type | Organization
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Legal Business Name | CREATIVITY THE ART OF EXPRESSION LLC
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Dates
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Enumeration Date | 01/23/2023
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 13002 WHITNELL WAY
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City | RIVERVIEW
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State | FL
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Zip | 33579-7098
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Country | US
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Telephone | 813-819-4346
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Fax |
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Provider Business Mailing Address
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Address Line | 13002 WHITNELL WAY
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City | RIVERVIEW
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State | FL
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Zip | 33579-7098
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Country | US
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Telephone | 813-819-4346
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | MS. KATHERINE HACKETTSIEROTA
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Credential | LMHC
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Telephone | 813-819-4346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number |
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License Number State |
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