MEDICARE: CREATIVE COUNSELING STRATEGIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1245609163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE COUNSELING STRATEGIES

Provider Business Mailing Address
First Line	:	2750 E W T HARRIS BLVD
Second Line	:	SUITE 207
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-4285
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 E W T HARRIS BLVD
Second Line	:	SUITE 207
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-4285
Country	:	US
Telephone Number	:	704-879-4269
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. CARLITA RANDALL
Credential	:
Telephone Number	:	412-977-1273

Provider Enumeration Date	:	09/21/2015
Last Update Date	:	09/21/2015

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