Organization
EXTENDING CREATIVE MINDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAVONTE DICKERSON MOTTLEY LCSW (COUNSELING)
(832) 506-8121
Entity
Organization
Contact information
Practice address
9723 HOMESTEAD, HOUSTON, TX 77016
(832) 506-8121
Mailing address
9723 HOMESTEAD RD, HOUSTON, TX 77016-4403
(832) 506-8121
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Enumeration date
05/04/2016
Last updated
05/04/2016
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