Provider Demographics
NPI:1659440469
Name:AGAPE CREATIVE MINISTRIES, INC.
Entity Type:Organization
Organization Name:AGAPE CREATIVE MINISTRIES, INC.
Other - Org Name:AGAPE CHRISTIAN COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR / THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVERA-CELDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:704-849-0144
Mailing Address - Street 1:2124 CROWN CENTRE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7804
Mailing Address - Country:US
Mailing Address - Phone:704-849-0144
Mailing Address - Fax:704-845-1611
Practice Address - Street 1:2124 CROWN CENTRE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7804
Practice Address - Country:US
Practice Address - Phone:704-849-0144
Practice Address - Fax:704-845-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02218OtherBLUE CROSS BLUE SHIELD