Provider Demographics
NPI:1790329688
Name:J M CREATIVE SERVICES LLC
Entity Type:Organization
Organization Name:J M CREATIVE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NDAMBUKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-538-8463
Mailing Address - Street 1:6916 LAMONT DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4607
Mailing Address - Country:US
Mailing Address - Phone:301-538-8463
Mailing Address - Fax:
Practice Address - Street 1:6916 LAMONT DR
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4607
Practice Address - Country:US
Practice Address - Phone:301-538-8463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12131068OtherCAQH
MDLC3069OtherLICENSE
DCPRC14114OtherLICENSE