Provider Demographics
NPI:1700042199
Name:ALTERNATIVE CREATIVE THERAPY
Entity Type:Organization
Organization Name:ALTERNATIVE CREATIVE THERAPY
Other - Org Name:SANDI HODGES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:HOSGES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-484-6996
Mailing Address - Street 1:2600 OLD FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-5676
Mailing Address - Country:US
Mailing Address - Phone:540-484-6996
Mailing Address - Fax:540-484-6935
Practice Address - Street 1:2600 OLD FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-5676
Practice Address - Country:US
Practice Address - Phone:540-484-6996
Practice Address - Fax:540-484-6935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL117071302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117071OtherBOARD CERTIFIED CLINICAL SUPERVISOR
FL117071OtherTHE NATIONAL BOARD OF CHRISTIAN CLINICAL THERAPIST
FLHH75172OtherNATIONAL CHRISTIAN COUNSELORS ASSOCIATION