Provider Demographics
NPI:1821352121
Name:ART OF CREATIVE DIMENSIONS, INC., THE
Entity Type:Organization
Organization Name:ART OF CREATIVE DIMENSIONS, INC., THE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEILA
Authorized Official - Middle Name:KAE
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CTC
Authorized Official - Phone:517-315-1367
Mailing Address - Street 1:4 N HOWELL ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-1780
Mailing Address - Country:US
Mailing Address - Phone:517-315-1367
Mailing Address - Fax:517-356-3267
Practice Address - Street 1:4 N HOWELL ST
Practice Address - Street 2:SUITE 260
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1780
Practice Address - Country:US
Practice Address - Phone:517-315-1367
Practice Address - Fax:517-356-3267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009781101Y00000X, 101YM0800X, 101YP2500X
MICC-XVW450025540101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty