Provider Demographics
NPI:1417599564
Name:CREEKSIDE COUNSELING, LLC
Entity Type:Organization
Organization Name:CREEKSIDE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:GIBSON
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:912-506-1587
Mailing Address - Street 1:PO BOX 2480
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:GA
Mailing Address - Zip Code:31305-2480
Mailing Address - Country:US
Mailing Address - Phone:912-506-1587
Mailing Address - Fax:
Practice Address - Street 1:7 SAINT ANDREWS CT
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-6764
Practice Address - Country:US
Practice Address - Phone:912-267-0774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty