Provider Demographics
NPI:1558177659
Name:CREATIVE OPPORTUNITIES FOR PERSONAL EMPOWERMENT, LLC
Entity type:Organization
Organization Name:CREATIVE OPPORTUNITIES FOR PERSONAL EMPOWERMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCMHC, LCASA
Authorized Official - Phone:704-247-7111
Mailing Address - Street 1:PO BOX 5649
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-1510
Mailing Address - Country:US
Mailing Address - Phone:704-247-7111
Mailing Address - Fax:
Practice Address - Street 1:455 CONCORD PKWY N UNIT 5649
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-6749
Practice Address - Country:US
Practice Address - Phone:704-247-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children