Provider Demographics
NPI:1700975521
Name:CENTER FOR CREATIVE GROWTH
Entity Type:Organization
Organization Name:CENTER FOR CREATIVE GROWTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:510-708-5504
Mailing Address - Street 1:2782 GOULARTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564
Mailing Address - Country:US
Mailing Address - Phone:510-708-5504
Mailing Address - Fax:800-783-8077
Practice Address - Street 1:2782 GOULARTE DRIVE
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564
Practice Address - Country:US
Practice Address - Phone:510-708-5504
Practice Address - Fax:800-783-8077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health