Provider Demographics
NPI:1508437179
Name:CREATIVE CHANGE COUNSELING, INC.
Entity Type:Organization
Organization Name:CREATIVE CHANGE COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BERTEE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D, LPC
Authorized Official - Phone:609-667-7353
Mailing Address - Street 1:668 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-5016
Mailing Address - Country:US
Mailing Address - Phone:609-668-4719
Mailing Address - Fax:609-667-7944
Practice Address - Street 1:322 E 5TH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3415
Practice Address - Country:US
Practice Address - Phone:609-668-4719
Practice Address - Fax:609-667-7944
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREATIVE CHANGE COUNSELING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)