Provider Demographics
NPI:1437645967
Name:CREATIVE COUNSELING LLC
Entity type:Organization
Organization Name:CREATIVE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLERE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-841-9077
Mailing Address - Street 1:77 MONTAUK DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-5305
Mailing Address - Country:US
Mailing Address - Phone:860-841-9077
Mailing Address - Fax:
Practice Address - Street 1:435 BUCKLAND RD.
Practice Address - Street 2:BRANDYWINE
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3720
Practice Address - Country:US
Practice Address - Phone:860-268-0305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002689101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty