Organization
CREATIVE FOUNDATIONS
Active
Other names
Creative Foundations
Organization subpart
No
Provider details
NPI number
Authorized official
KENYETTA MASSEY (CEO)
(252) 529-9054
Entity
Organization
Contact information
Practice address
1775 GRAHAM AVE STE 103, HENDERSON, NC 27536-2996
(252) 529-9054
Mailing address
8229 WILLOWGLEN DR, RALEIGH, NC 27616-3346
(252) 529-9054
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3418608
—
NC
05
—
6006505
—
NC
05
—
8302451B
—
NC
05
—
8302451G
—
NC
Enumeration date
08/19/2008
Last updated
02/11/2009
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