Organization
CREATIVE RESTORATION AND GUIDANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS CHRISTISHAWN GORE MA LPC, NCC, LCAS-A (PRESIDENT)
(919) 824-7789
Entity
Organization
Contact information
Practice address
8303 PLANO CT, RALEIGH, NC 27616-6640
(919) 824-7789
Mailing address
PO BOX 220, ROLESVILLE, NC 27571-0220
(919) 824-7789
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
10017
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19GVD
BLUE CROSS BLUE SHIELD
NC
Enumeration date
03/21/2017
Last updated
03/21/2017
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