Organization
CREATIVE COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SONYA RENEE OGLESBY LPC, NCC, LCAS-A (CEO)
(336) 830-4765
Entity
Organization
Contact information
Practice address
163 STRATFORD CT, SUITE #170, WINSTON SALEM, NC 27103-1836
(336) 448-4123
(336) 436-9123
Mailing address
163 STRATFORD CT, SUITE #170, WINSTON SALEM, NC 27103-1836
(336) 448-4123
(336) 436-9123
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
3028-A
NC
101YM0800X
Mental Health Counselor
8040
NC
101YP2500X
Professional Counselor
Primary
8040
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6115116
—
NC
Enumeration date
08/20/2015
Last updated
08/20/2015
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