Organization
CREATE IT KIDS CLUB, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMEKA ANDERSON (BEHAVIOR SPECIALIST)
(678) 235-4333
Entity
Organization
Contact information
Practice address
1425 MARKET BLVD STE 530-251, ROSWELL, GA 30076-6708
(678) 235-4333
Mailing address
1425 MARKET BLVD STE 530-251, ROSWELL, GA 30076-6708
(678) 235-4333
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
385HR2050X
Respite Care Camp
—
—
Other
Enumeration date
05/29/2018
Last updated
05/29/2018
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