Provider Demographics
NPI:1184017089
Name:THE CREATIVE CHANCE
Entity Type:Organization
Organization Name:THE CREATIVE CHANCE
Other - Org Name:THE CREATIVE CHAMPS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDS
Authorized Official - Phone:813-716-5170
Mailing Address - Street 1:602 E ALEXANDER ST
Mailing Address - Street 2:1108
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-7161
Mailing Address - Country:US
Mailing Address - Phone:813-716-5170
Mailing Address - Fax:
Practice Address - Street 1:1803 C COLLINS COMMON JAMES REDMAN PARKWAY
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563
Practice Address - Country:US
Practice Address - Phone:813-715-5170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty