Provider Demographics
NPI:1124615315
Name:CREATIVE CREATIVE CENTER, INC.
Entity type:Organization
Organization Name:CREATIVE CREATIVE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:ALIFF
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:301-706-6889
Mailing Address - Street 1:105 MILKY WAY
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-8241
Mailing Address - Country:US
Mailing Address - Phone:717-477-2556
Mailing Address - Fax:717-496-0346
Practice Address - Street 1:130 S PENN ST STE 201
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-1916
Practice Address - Country:US
Practice Address - Phone:717-477-2556
Practice Address - Fax:717-496-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty