Provider Demographics
NPI:1922213727
Name:CREATIVE CHANGES COUNSELING CENTER
Entity Type:Organization
Organization Name:CREATIVE CHANGES COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:CHRISITNE
Authorized Official - Last Name:OHARA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-620-6559
Mailing Address - Street 1:2725 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1335
Mailing Address - Country:US
Mailing Address - Phone:757-620-6559
Mailing Address - Fax:757-422-4162
Practice Address - Street 1:1092 LASKIN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6362
Practice Address - Country:US
Practice Address - Phone:757-620-6559
Practice Address - Fax:757-422-4162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0803162OtherOPTIMA PROVIDER NUMBER
185749OtherANTHEM PROVIDER NUMBER