Provider Demographics
NPI:1083759120
Name:CREATIVE COUNSELING & THERAPY
Entity Type:Organization
Organization Name:CREATIVE COUNSELING & THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:MCGOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC ATR-BC
Authorized Official - Phone:856-546-0021
Mailing Address - Street 1:618 S WHITE HORSE PIKE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:AUDUBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08106-1315
Mailing Address - Country:US
Mailing Address - Phone:856-546-0021
Mailing Address - Fax:856-546-6167
Practice Address - Street 1:618 S WHITE HORSE PIKE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:AUDUBON
Practice Address - State:NJ
Practice Address - Zip Code:08106-1315
Practice Address - Country:US
Practice Address - Phone:856-546-0021
Practice Address - Fax:856-546-6167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00048400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty