Provider Demographics
NPI:1366862930
Name:CREATIVE BEHAVIOR CONSULTING
Entity Type:Organization
Organization Name:CREATIVE BEHAVIOR CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA, LPC
Authorized Official - Phone:570-982-9436
Mailing Address - Street 1:6212 NORTHLAKE CIRCLE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345
Mailing Address - Country:US
Mailing Address - Phone:570-982-9436
Mailing Address - Fax:678-669-2632
Practice Address - Street 1:6212 NORTHLAKE CIRCLE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345
Practice Address - Country:US
Practice Address - Phone:570-982-9436
Practice Address - Fax:678-669-2632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 007330101YP2500X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty