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NPI Code Detail

MEDICARE: AGAPE CREATIVE MINISTRIES, INC.

MEDICARE: AGAPE CREATIVE MINISTRIES, INC.
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
1101YP2500XProfessional Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
102218OTHERNCBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1659440469
Entity Type Code : Organization
Provider Name (Legal Business Name) : AGAPE CREATIVE MINISTRIES, INC.
Provider Business Mailing Address
First Line : 2124 CROWN CENTRE DR
Second Line : SUITE 400
City : CHARLOTTE
State : NC
Zip : 28227-7804
Country : US
Telephone Number : 704-849-0144
Fax Number : 704-845-1611
Provider Business Practice Location Address
First Line : 2124 CROWN CENTRE DR
Second Line : SUITE 400
City : CHARLOTTE
State : NC
Zip : 28227-7804
Country : US
Telephone Number : 704-849-0144
Fax Number : 704-845-1611
Authorized Official
Title or Position : EXECUTIVE DIRECTOR / THERAPIST
Name : MRS. GALINA OLIVERA-CELDRAN
Credential : LPC-S
Telephone Number : 704-849-0144
Provider Enumeration Date : 11/07/2006
Last Update Date : 07/07/2016

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