Provider Demographics
NPI:1558608158
Name:CREATIVE COUNSELING AND CONSULTATIVE SERVICES
Entity Type:Organization
Organization Name:CREATIVE COUNSELING AND CONSULTATIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATERESEA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:804-525-4101
Mailing Address - Street 1:2423 LAMB AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-4419
Mailing Address - Country:US
Mailing Address - Phone:804-525-4101
Mailing Address - Fax:804-525-4102
Practice Address - Street 1:2423 LAMB AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-4419
Practice Address - Country:US
Practice Address - Phone:804-525-4101
Practice Address - Fax:804-525-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005286101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty