Provider Demographics
NPI:1083358873
Name:CREATIVE CONVERSATIONS THERAPY AND SUPERVISION PLLC
Entity Type:Organization
Organization Name:CREATIVE CONVERSATIONS THERAPY AND SUPERVISION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:LASHELL
Authorized Official - Last Name:OVERSTREET
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LCMHC, QS
Authorized Official - Phone:704-277-7718
Mailing Address - Street 1:8535 WINTER OAKS LN APT 203
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-5559
Mailing Address - Country:US
Mailing Address - Phone:704-277-7718
Mailing Address - Fax:
Practice Address - Street 1:8535 WINTER OAKS LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-5596
Practice Address - Country:US
Practice Address - Phone:704-277-7718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health