Provider Demographics
NPI:1821853425
Name:CREATIVE COUNSELING TRAUMA CENTER FOR CHILDREN AND ADULTS
Entity Type:Organization
Organization Name:CREATIVE COUNSELING TRAUMA CENTER FOR CHILDREN AND ADULTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRAUMA THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-288-2040
Mailing Address - Street 1:222 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3503
Mailing Address - Country:US
Mailing Address - Phone:570-288-2040
Mailing Address - Fax:
Practice Address - Street 1:222 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3503
Practice Address - Country:US
Practice Address - Phone:570-288-2040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty