Organization
CREATIVE PATH COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LINA LACASSE (PRESIDENT)
(203) 706-9325
Entity
Organization
Contact information
Practice address
16069 TAMPA ST, BROOKSVILLE, FL 34604-8458
(203) 706-9325
Mailing address
16069 TAMPA ST, BROOKSVILLE, FL 34604-8458
(203) 706-9325
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L220-520-68-662-0
FLORIDA DRIVER LICENSE
FL
Enumeration date
05/11/2021
Last updated
05/11/2021
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