Provider Demographics
NPI:1568224665
Name:KREATIVE MILESTONES BEHAVIORAL HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:KREATIVE MILESTONES BEHAVIORAL HEALTHCARE SERVICES, LLC
Other - Org Name:KREATIVE MILESTONE BEHAVIORAL HEALTHCARE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-344-0536
Mailing Address - Street 1:712 MOBJACK PL STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1981
Mailing Address - Country:US
Mailing Address - Phone:757-344-0536
Mailing Address - Fax:757-782-2861
Practice Address - Street 1:712 MOBJACK PL STE A
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1981
Practice Address - Country:US
Practice Address - Phone:757-344-0536
Practice Address - Fax:757-782-2861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty