Provider Demographics
NPI:1225484348
Name:LOUISA CREATIVE COUNSELING, LLC
Entity Type:Organization
Organization Name:LOUISA CREATIVE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZZANELLA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, RPT, CCTP
Authorized Official - Phone:540-604-3267
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:MINERAL
Mailing Address - State:VA
Mailing Address - Zip Code:23117-0192
Mailing Address - Country:US
Mailing Address - Phone:540-604-3267
Mailing Address - Fax:844-480-1755
Practice Address - Street 1:421 MINERAL AVE # 192
Practice Address - Street 2:
Practice Address - City:MINERAL
Practice Address - State:VA
Practice Address - Zip Code:23117-4049
Practice Address - Country:US
Practice Address - Phone:540-259-3646
Practice Address - Fax:540-259-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-07
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA0701006594251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA601101224Medicaid