Provider Demographics
NPI:1336794007
Name:CREATIVE CHANGE COUNSELING, INC.
Entity type:Organization
Organization Name:CREATIVE CHANGE COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BERTEE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSY D
Authorized Official - Phone:609-667-7353
Mailing Address - Street 1:774 EAYRESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-3100
Mailing Address - Country:US
Mailing Address - Phone:609-221-6817
Mailing Address - Fax:609-667-7944
Practice Address - Street 1:774 EAYRESTOWN RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-3100
Practice Address - Country:US
Practice Address - Phone:609-221-6817
Practice Address - Fax:609-667-7944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility