Provider Demographics
NPI:1881194074
Name:CREATIVE COUNSELING, LLC
Entity type:Organization
Organization Name:CREATIVE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUSSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-592-1070
Mailing Address - Street 1:107 BARTLEY DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-2623
Mailing Address - Country:US
Mailing Address - Phone:540-592-1070
Mailing Address - Fax:
Practice Address - Street 1:606 S MARKET ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5012
Practice Address - Country:US
Practice Address - Phone:540-592-1070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040083201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty