Organization
CREATIVE FOUNDATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENYETTA MASSEY (EXECUTIVE DIRECTOR)
(252) 529-9054
Entity
Organization
Contact information
Practice address
1775 GRAHAM AVE, SUITE 103, HENDERSON, NC 27536-5948
(252) 529-9054
(252) 572-4981
Mailing address
1775 GRAHAM AVE, SUITE 103, HENDERSON, NC 27536-5948
(252) 529-9054
(252) 572-4981
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
251B00000X
Case Management Agency
—
—
Other
Enumeration date
01/27/2010
Last updated
01/27/2010
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