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General NPI Number Information
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NPI Number | 1861245920
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Entity Type | Organization
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Legal Business Name | CREATIVE CHANGE COUNSELING LLC
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Dates
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Enumeration Date | 04/09/2024
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 10 HIGGINS HWY STE 14
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City | MANSFIELD CENTER
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State | CT
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Zip | 06250-1437
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Country | US
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Telephone | 860-933-1356
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 151
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City | WILLIMANTIC
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State | CT
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Zip | 06226-0151
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Country | US
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Telephone | 860-933-1356
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | LAURIANN ZANE
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Credential | LADC
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Telephone | 860-933-1356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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