Provider Demographics
NPI:1356777379
Name:CREATIVE MANAGEMENT SOURCE, INC.
Entity type:Organization
Organization Name:CREATIVE MANAGEMENT SOURCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:HELENE
Authorized Official - Last Name:HENDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-292-5478
Mailing Address - Street 1:PO BOX 16851
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27416-0851
Mailing Address - Country:US
Mailing Address - Phone:336-292-5478
Mailing Address - Fax:336-617-5948
Practice Address - Street 1:3407 W WENDOVER AVE
Practice Address - Street 2:SUITE G
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1581
Practice Address - Country:US
Practice Address - Phone:336-292-5478
Practice Address - Fax:336-617-5948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health