Provider Demographics
NPI:1992061170
Name:KREATIVE COUNSELING GROUP
Entity type:Organization
Organization Name:KREATIVE COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:VANLOW
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:804-933-2082
Mailing Address - Street 1:4410 EAST CLAIBORNE SQUARE
Mailing Address - Street 2:SUITE 334/OFFICE 321
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666
Mailing Address - Country:US
Mailing Address - Phone:804-933-2082
Mailing Address - Fax:
Practice Address - Street 1:4410 CLAIBORNE SQ E
Practice Address - Street 2:SUITE 334/OFFICE 321
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2071
Practice Address - Country:US
Practice Address - Phone:804-933-2082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health