Organization
CREEKSIDE THERAPEUTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA COLEMAN LPC, BCBA (OWNER)
(434) 515-2041
Entity
Organization
Contact information
Practice address
137 LAXTON RD STE 200, LYNCHBURG, VA 24502-5294
(434) 515-2041
Mailing address
137 LAXTON RD STE 200, LYNCHBURG, VA 24502-5294
(434) 515-2041
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
103K00000X
Behavior Analyst
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30017547490002
—
VA
Enumeration date
04/19/2023
Last updated
08/14/2024
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