Provider Demographics
NPI:1144065418
Name:CREATIVE LIVING ALLIANCE LLC
Entity type:Organization
Organization Name:CREATIVE LIVING ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURDA-WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PRE-LIC PC
Authorized Official - Phone:267-597-7679
Mailing Address - Street 1:1206 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19067-2417
Mailing Address - Country:US
Mailing Address - Phone:267-597-7679
Mailing Address - Fax:
Practice Address - Street 1:1206 OHIO AVE
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:PA
Practice Address - Zip Code:19067-2417
Practice Address - Country:US
Practice Address - Phone:267-597-7679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty