Provider Demographics
NPI:1053834465
Name:CREATIVE CONNECTIONS PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:CREATIVE CONNECTIONS PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:304-460-8151
Mailing Address - Street 1:260 JACK ACRES RD
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-6506
Mailing Address - Country:US
Mailing Address - Phone:304-460-8151
Mailing Address - Fax:
Practice Address - Street 1:1120 SANDY CREEK RD
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:WV
Practice Address - Zip Code:26440-7614
Practice Address - Country:US
Practice Address - Phone:304-460-8151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009436831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty