Provider Demographics
NPI:1992470280
Name:ALABASTER CREATIVE ARTS THERAPY
Entity Type:Organization
Organization Name:ALABASTER CREATIVE ARTS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MENDEZ CARMONA
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:330-641-4413
Mailing Address - Street 1:132 S MARKET ST STE 204
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-4765
Mailing Address - Country:US
Mailing Address - Phone:330-641-4413
Mailing Address - Fax:
Practice Address - Street 1:132 S MARKET ST STE 204
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-4765
Practice Address - Country:US
Practice Address - Phone:330-641-4413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty