Organization
CREATIVE COUNSELING CENTERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GWEN ANN MUNDORF L.C.S.W. (OWNER/DIRECTOR)
(321) 615-0990
Entity
Organization
Contact information
Practice address
3270 SUNTREE BLVD, SUITE 2233, MELBOURNE, FL 32940-7530
(321) 615-0990
(888) 341-8272
Mailing address
5972 GOLETA CIR, MELBOURNE, FL 32940-8035
(321) 615-0990
(888) 341-8272
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
SW10736
FL
Other
Enumeration date
08/19/2013
Last updated
07/27/2014
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