Provider Demographics
NPI:1174329304
Name:CREATIVE CONTINUUM THERAPY LLC
Entity type:Organization
Organization Name:CREATIVE CONTINUUM THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:STEPHANIE
Authorized Official - Last Name:DOERING
Authorized Official - Suffix:
Authorized Official - Credentials:LPC ATR-BC
Authorized Official - Phone:480-442-0325
Mailing Address - Street 1:4641 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-4095
Mailing Address - Country:US
Mailing Address - Phone:480-442-0325
Mailing Address - Fax:
Practice Address - Street 1:4641 N 12TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-4095
Practice Address - Country:US
Practice Address - Phone:480-442-0325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty