Provider Demographics
NPI:1073093217
Name:CREATIVE CARE, LLC
Entity Type:Organization
Organization Name:CREATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DR. BETTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFF, PSY.D.
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:727-318-1353
Mailing Address - Street 1:6146 LYNN LAKE DR S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-6115
Mailing Address - Country:US
Mailing Address - Phone:727-318-1353
Mailing Address - Fax:
Practice Address - Street 1:6146 LYNN LAKE DR S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-6115
Practice Address - Country:US
Practice Address - Phone:727-318-1353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities