Provider Demographics
NPI:1972904928
Name:CREATIVE COUNSELING AND ENLIGHTENMENT CENTER LLC
Entity type:Organization
Organization Name:CREATIVE COUNSELING AND ENLIGHTENMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DECOTIIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-221-7979
Mailing Address - Street 1:320 RARITAN AVE STE 307D
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2752
Mailing Address - Country:US
Mailing Address - Phone:732-221-7378
Mailing Address - Fax:732-985-8060
Practice Address - Street 1:320 RARITAN AVE STE 307D
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2752
Practice Address - Country:US
Practice Address - Phone:732-221-7378
Practice Address - Fax:732-985-8060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health