Provider Demographics
NPI:1396049482
Name:CREATIVE PSYCHOTHERAPY, PC
Entity type:Organization
Organization Name:CREATIVE PSYCHOTHERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:AULD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LCSW,NBCCH
Authorized Official - Phone:919-848-9715
Mailing Address - Street 1:185 WIND CHIME CT
Mailing Address - Street 2:#104
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6481
Mailing Address - Country:US
Mailing Address - Phone:919-848-9715
Mailing Address - Fax:919-848-9716
Practice Address - Street 1:185 WIND CHIME CT
Practice Address - Street 2:#104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6481
Practice Address - Country:US
Practice Address - Phone:919-848-9715
Practice Address - Fax:919-848-9716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0062271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty