Organization
CREATIVE CONCEPTS THERAPEUTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AESHIA JACKSON (PRESIDENT)
(910) 315-4487
Entity
Organization
Contact information
Practice address
100 PEAR ST, ABERDEEN, NC 28315-2924
(910) 528-6172
Mailing address
PO BOX 3594, PINEHURST, NC 28374-3594
(910) 315-4487
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003142761
—
NC
Enumeration date
11/27/2018
Last updated
01/08/2020
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