Provider Demographics
NPI:1588492458
Name:IMAGINATIVE THERAPIES, LLC
Entity type:Organization
Organization Name:IMAGINATIVE THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JADE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-772-1527
Mailing Address - Street 1:107 COLONY CT
Mailing Address - Street 2:
Mailing Address - City:WALKERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21793-8246
Mailing Address - Country:US
Mailing Address - Phone:240-772-1527
Mailing Address - Fax:
Practice Address - Street 1:107 COLONY CT
Practice Address - Street 2:
Practice Address - City:WALKERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21793-8246
Practice Address - Country:US
Practice Address - Phone:240-772-1527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty