Provider Demographics
NPI:1124480926
Name:CREATIVE COUNSELING AND WELLNESS LLC
Entity type:Organization
Organization Name:CREATIVE COUNSELING AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARBO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:484-571-8919
Mailing Address - Street 1:905 CHARLESTON GRN
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2457
Mailing Address - Country:US
Mailing Address - Phone:484-571-8919
Mailing Address - Fax:
Practice Address - Street 1:47 MARCHWOOD RD
Practice Address - Street 2:SUITE 2A-8
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1835
Practice Address - Country:US
Practice Address - Phone:484-571-8919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW 015583251S00000X
PAPC007162251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health