Provider Demographics
NPI:1598398174
Name:EXPRESSIONISTS CREATIVE COUNSELING, LLC
Entity Type:Organization
Organization Name:EXPRESSIONISTS CREATIVE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:KING
Authorized Official - Last Name:SCHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, REAT, NCC
Authorized Official - Phone:407-502-0189
Mailing Address - Street 1:445 AUTUMN OAKS PL
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4848
Mailing Address - Country:US
Mailing Address - Phone:407-620-8102
Mailing Address - Fax:
Practice Address - Street 1:122 N 4TH ST STE 2022
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2944
Practice Address - Country:US
Practice Address - Phone:407-502-0189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty