Provider Demographics
NPI:1477381143
Name:CREATING CHANGE COUNSELING CENTER
Entity type:Organization
Organization Name:CREATING CHANGE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-703-4642
Mailing Address - Street 1:68 MCGREGOR AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07856-1007
Mailing Address - Country:US
Mailing Address - Phone:973-703-4642
Mailing Address - Fax:
Practice Address - Street 1:181 HOWARD BLVD STE J
Practice Address - Street 2:
Practice Address - City:MOUNT ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07856-2314
Practice Address - Country:US
Practice Address - Phone:973-703-4642
Practice Address - Fax:973-810-3010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty