Healthcare Provider Details

I. General information

NPI: 1508327305
Provider Name (Legal Business Name): CREATING CONSCIOUS CONNECTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 POWERS FERRY ROAD BUILDING 21 - SUITE 350
ATLANTA GA
30339
US

IV. Provider business mailing address

3315 SOUTH COBB DRIVE SUITE 700 #813386
SMYRNA GA
30080
US

V. Phone/Fax

Practice location:
  • Phone: 770-956-1056
  • Fax:
Mailing address:
  • Phone: 770-956-1056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT MATHIS
Title or Position: OWNER
Credential: LCSW
Phone: 770-956-1056