Provider Demographics
NPI:1033958558
Name:ANNIES CREATIVE COUNSELING PLLC
Entity type:Organization
Organization Name:ANNIES CREATIVE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:843-557-8946
Mailing Address - Street 1:4708 STONEY BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-6611
Mailing Address - Country:US
Mailing Address - Phone:843-557-8946
Mailing Address - Fax:
Practice Address - Street 1:18407 W CATAWBA AVE
Practice Address - Street 2:203
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5688
Practice Address - Country:US
Practice Address - Phone:704-350-5486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty