Organization
CREATIVE CHANGE COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BERTEE THOMAS (PROGRAM OPERATIONS EXECUTIVE DIRECT)
(609) 668-4719
Entity
Organization
Contact information
Practice address
423 7TH AVE SW, HICKORY, NC 28602-3237
(609) 668-4719
Mailing address
774 EAYRESTOWN RD, SUITE 204, LUMBERTON, NJ 08048-3100
(609) 668-4719
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
—
NJ
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0506460
—
NJ
05
—
1053794065
—
NC
Enumeration date
07/08/2015
Last updated
05/15/2022
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