Provider Demographics
NPI:1497941355
Name:CREATIVE SELF-DEVELOPMENT, INC.
Entity Type:Organization
Organization Name:CREATIVE SELF-DEVELOPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LILLI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VINCENZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:703-532-2731
Mailing Address - Street 1:1909 N OHIO ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-2136
Mailing Address - Country:US
Mailing Address - Phone:703-532-2731
Mailing Address - Fax:
Practice Address - Street 1:1909 N OHIO ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-2136
Practice Address - Country:US
Practice Address - Phone:703-532-2731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701000871251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health