Provider Demographics
NPI:1619701612
Name:CREATIVE CHANGE COUNSELING
Entity type:Organization
Organization Name:CREATIVE CHANGE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BERTEE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD
Authorized Official - Phone:609-668-4719
Mailing Address - Street 1:950 S CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-1271
Mailing Address - Country:US
Mailing Address - Phone:609-668-4719
Mailing Address - Fax:
Practice Address - Street 1:668 MAIN STREET
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-0516
Practice Address - Country:US
Practice Address - Phone:609-668-4719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker