Provider Demographics
NPI:1861805731
Name:CREATIVE EXPRESSIONS COUNSELING AND PLAY THERAPY LLC
Entity type:Organization
Organization Name:CREATIVE EXPRESSIONS COUNSELING AND PLAY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LANA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC, RPT
Authorized Official - Phone:678-469-0349
Mailing Address - Street 1:PO BOX 674
Mailing Address - Street 2:
Mailing Address - City:ADAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30103-0674
Mailing Address - Country:US
Mailing Address - Phone:678-469-0349
Mailing Address - Fax:770-773-1500
Practice Address - Street 1:321 N MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:ADAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30103-2438
Practice Address - Country:US
Practice Address - Phone:678-469-0349
Practice Address - Fax:770-773-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-08
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006484101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1801173646OtherINDIVIDUAL NPI