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CREATIVE CHANGE COUNSELING CENTER, P.C.

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Company Details

Legal Name: CREATIVE CHANGE COUNSELING CENTER, P.C.
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL SERVICE CORPORATION
Category: DOMESTIC ENTITY
Status: Administratively Dissolved
Formation/ Registration Date: November 23rd 2009
Date of Dissolution: September 3rd 2015
Expiration date: 30 Nov 2015
UBI Number: 602 971 489

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Registered Agent Information

Name Role Address
FOREST EWOODLEY Registered Agent 200 S TOBIN ST #A, RENTON, WA, 98057, UNITED STATES

Key Officers & Management

Name Role Address
FOREST WOODLEY Governing Person 200 S TOBIN STE A, RENTON, WA, 98057, UNITED STATES
SYLVIA BELL-WOODLEY Governing Person 200 S TOBIN ST #A, RENTON, WA, 98057, UNITED STATES

National Provider Identifier

NPI Number:
1952716821

Authorized Person:

Name:
MS. DAVIDA LEIGHTON
Role:
COUNSELOR
Phone:

Taxonomy:

Selected Taxonomy:
1041C0700X - Clinical Social Worker
Is Primary:
Yes

Contacts:

Fax:
4252555523
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