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Organization
EXTENDING CREATIVE MINDS
Active
Organization
EXTENDING CREATIVE MINDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAKISHA R DICKERSON (CHIEF EXECUTIVE OFFICER)
(832) 506-8121
Entity
Organization
Contact information
Practice address
10311 HOMESTEAD RD, HOUSTON, TX 77016-3305
(832) 506-8121
(832) 717-2781
Mailing address
10311 HOMESTEAD RD, HOUSTON, TX 77016-3305
(832) 506-8121
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
08693
TX
1041C0700X
Clinical Social Worker
57323
TX
1835P1300X
Psychiatric Pharmacist
33415
TX
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
2084P0800X
Psychiatry Physician
K8989
TX
Other
Enumeration date
04/22/2016
Last updated
05/30/2017
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