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General NPI Number Information
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NPI Number | 1861648925
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Entity Type | Organization
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Legal Business Name | CREATIVE COUNSELING, LLC
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Dates
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Enumeration Date | 08/08/2008
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 36 MILL PLAIN RD SUITE 306
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City | DANBURY
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State | CT
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Zip | 06811-5181
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Country | US
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Telephone | 203-207-9944
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Fax |
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Provider Business Mailing Address
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Address Line | 36 MILL PLAIN RD SUITE 306
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City | DANBURY
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State | CT
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Zip | 06811-5181
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Country | US
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Telephone | 203-207-9944
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Fax |
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Authorized Official
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Title or Position | DIRECTOR AND MANAGER
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Name | LUCILLE C PAYNE
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Credential | LPC
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Telephone | 203-207-9944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 001430
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License Number State | CT
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