Provider Demographics
NPI:1205027398
Name:THE CENTER FOR CREATIVE GROWTH AND HUMAN DEVELOPMENT, INC.
Entity type:Organization
Organization Name:THE CENTER FOR CREATIVE GROWTH AND HUMAN DEVELOPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCAMEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW, LPC
Authorized Official - Phone:706-884-1080
Mailing Address - Street 1:111B CORPORATE PARK EAST DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-3680
Mailing Address - Country:US
Mailing Address - Phone:706-884-1080
Mailing Address - Fax:706-812-8866
Practice Address - Street 1:111B CORPORATE PARK EAST DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-3680
Practice Address - Country:US
Practice Address - Phone:706-884-1080
Practice Address - Fax:706-812-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health