| Creative Space Child Therapy, LLC. | |
|
5304 Cedar Dr Cambridge MD 21613-4404 | |
| (410) 929-7427 | |
| Not Available |
| Full Name | Creative Space Child Therapy, LLC. |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 5304 Cedar Dr, Cambridge, Maryland |
| Authorized Official Name and Position | Latrice Kiane Gray (OWNER) |
| Authorized Official Contact | 4109297427 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Creative Space Child Therapy, LLC. 5304 Cedar Dr Cambridge MD 21613-4404 Ph: (410) 929-7427 | Creative Space Child Therapy, LLC. 5304 Cedar Dr Cambridge MD 21613-4404 Ph: (410) 929-7427 |
| NPI Number | 1255085056 |
|---|---|
| Provider Enumeration Date | 02/10/2022 |
| Last Update Date | 02/10/2022 |
| Certification Date | 02/10/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255085056 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (NU) | Primary |
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