Provider Demographics
NPI:1639790629
Name:CREATIVE CARE HEALING COUNSELING & CONSULTING
Entity Type:Organization
Organization Name:CREATIVE CARE HEALING COUNSELING & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:561-248-4831
Mailing Address - Street 1:410 EVERNIA ST APT 221
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5433
Mailing Address - Country:US
Mailing Address - Phone:561-248-4831
Mailing Address - Fax:
Practice Address - Street 1:410 EVERNIA ST APT 221
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5433
Practice Address - Country:US
Practice Address - Phone:561-248-4831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty