=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851126494
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CREATE RESEARCH, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2024
-----------------------------------------------------
Last Update Date | 10/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 157 MEDICAL PARK DR # A
-----------------------------------------------------
City | BREVARD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28712-4189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-884-3440
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 680 HART RD
-----------------------------------------------------
City | PISGAH FOREST
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28768-8637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-226-0314
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SARAH FENTRESS LEWIS
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 828-226-0314
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------