Provider Demographics
NPI:1720317324
Name:CREATIVE THERAPIES, INC.
Entity Type:Organization
Organization Name:CREATIVE THERAPIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-857-1248
Mailing Address - Street 1:PO BOX 282
Mailing Address - Street 2:430 N. ALBERT STREET
Mailing Address - City:BISHOPVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29010-0282
Mailing Address - Country:US
Mailing Address - Phone:443-857-1248
Mailing Address - Fax:
Practice Address - Street 1:430 ALBERT ST
Practice Address - Street 2:
Practice Address - City:BISHOPVILLE
Practice Address - State:SC
Practice Address - Zip Code:29010-1202
Practice Address - Country:US
Practice Address - Phone:443-857-1248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9089251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health