Provider Demographics
NPI:1124308374
Name:CREATIVE CLINICAL SOLUTIONS, LLC
Entity type:Organization
Organization Name:CREATIVE CLINICAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:803-608-1373
Mailing Address - Street 1:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-0968
Mailing Address - Country:US
Mailing Address - Phone:864-836-7220
Mailing Address - Fax:864-294-1774
Practice Address - Street 1:21 PLAZA DR STE B
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-1662
Practice Address - Country:US
Practice Address - Phone:864-836-7220
Practice Address - Fax:864-294-1774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health