Provider Demographics
NPI:1245699305
Name:CREATIVE HEALING COUNSELING & WELLNESS CENTER
Entity type:Organization
Organization Name:CREATIVE HEALING COUNSELING & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-219-9060
Mailing Address - Street 1:2810 MORRIS AVE
Mailing Address - Street 2:SUITE 102B
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4850
Mailing Address - Country:US
Mailing Address - Phone:908-219-9060
Mailing Address - Fax:
Practice Address - Street 1:2810 MORRIS AVE
Practice Address - Street 2:SUITE 102B
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-4850
Practice Address - Country:US
Practice Address - Phone:908-219-9060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055953001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty