Provider Demographics
NPI:1285289629
Name:CENTER FOR CREATIVE VALUES
Entity type:Organization
Organization Name:CENTER FOR CREATIVE VALUES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ATOLOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-929-8315
Mailing Address - Street 1:515 E. JOPPA RD SUITE 100 & 104
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286
Mailing Address - Country:US
Mailing Address - Phone:410-337-0938
Mailing Address - Fax:410-337-2104
Practice Address - Street 1:515 E. JOPPA RD SUITE 100 & 104
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:410-337-0938
Practice Address - Fax:410-337-2104
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR CREATIVE VALUES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-02
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health