Organization
CREATIVE SPACE CHILD THERAPY, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATRICE KIANE GRAY LCSW-C (OWNER)
(410) 929-7427
Entity
Organization
Contact information
Practice address
5304 CEDAR DR, CAMBRIDGE, MD 21613-4404
(410) 929-7427
Mailing address
5304 CEDAR DR, CAMBRIDGE, MD 21613-4404
(410) 929-7427
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
02/10/2022
Last updated
02/10/2022
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