Creech Road Supervised Gare

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MHL 092761 Issued in NC

Legal business name

CREECH ROAD SUPERVISED GARE

Practice address

311 New Bern Ave
# 27991
Raleigh, NC 27611-0801

Phone

(919) 961-1392

NPI assigned

Nov 15, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Ezekiel Wilson Jr.

Title

Owner

Phone

(919) 961-1392

Specialties & licenses 1

Addresses

Other names 1

• Ezekiel Wilson Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352937600000",
    "number": "1689918641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 CREECH RD",
            "city": "GARNER",
            "state": "NC",
            "postal_code": "275292916",
            "telephone_number": "919-961-1392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 NEW BERN AVE",
            "address_2": "# 27991",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276110801",
            "telephone_number": "919-961-1392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREECH ROAD SUPERVISED GARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-15",
        "last_updated": "2012-11-15",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "EZEKIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-961-1392",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "MHL 092761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ezekiel Wilson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Creative Kind ABA LLC
• Creative Psychotherapy, PC
• Creative Restoration and Guidance
• Creative Therapies, PLLC
• Crecer Therapy & Counseling PLLC
• Adam Creech, MD
• Heather Creech, MED, BCBA, LBA
• Jessica Elizabeth Creech, OTD, OTR/L
• Mary Frances Creech, RD
• Trey Braxton Creech, MD

• Mental Health Counselor in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.