Provider Demographics
NPI:1417704529
Name:CEDAR CREEK COUNSELING PLLC
Entity type:Organization
Organization Name:CEDAR CREEK COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWA
Authorized Official - Phone:704-773-2068
Mailing Address - Street 1:2012 PLEASANT GROVE CH RD
Mailing Address - Street 2:
Mailing Address - City:MARSHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28103-9052
Mailing Address - Country:US
Mailing Address - Phone:704-773-2068
Mailing Address - Fax:
Practice Address - Street 1:200 TOMBERLIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4006
Practice Address - Country:US
Practice Address - Phone:704-773-2068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty