Organization
CREATIVE PSYCHOLOGY CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH D RUSSELL PHD, LMSW (PRESIDENT)
(586) 447-0130
Entity
Organization
Contact information
Practice address
20816 E 11 MILE RD, SUITE #113, SAINT CLAIR SHORES, MI 48081-1565
(586) 447-0130
Mailing address
20816 E 11 MILE RD, SUITE #113, SAINT CLAIR SHORES, MI 48081-1565
(586) 447-0130
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801012479
MI
Other
Enumeration date
03/05/2008
Last updated
03/05/2008
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