Provider Demographics
NPI:1396937090
Name:CREATIVE INC.
Entity type:Organization
Organization Name:CREATIVE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NIANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-914-0015
Mailing Address - Street 1:803 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-4625
Mailing Address - Country:US
Mailing Address - Phone:910-914-0015
Mailing Address - Fax:910-914-0015
Practice Address - Street 1:803 S MADISON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-4625
Practice Address - Country:US
Practice Address - Phone:910-914-0015
Practice Address - Fax:910-914-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management