| Organization Name: | CREATIVE CHANGE COUNSELING |
| NPI Number: | 1053794065 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JENNIFER MARTIN (PROGRAM OPERATIONS EXECUTIVE DIRECT) |
| Mailing Address: | 774 Eayrestown Rd Suite 204 Lumberton |
| State: | NJ US |
| Postal Code: | 080483100 |
| Phone Number: | 6098644428 |
| Fax Number: | |
| NPI Enumeration Date: | 07/08/2015 |
| NPI Last Update Date: | 07/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |