Healthcare Provider Details

I. General information

NPI: 1558225508
Provider Name (Legal Business Name): CONSCIOUS LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3517 STONELEIGH WALK
LITHONIA GA
30038-3291
US

IV. Provider business mailing address

3517 STONELEIGH WALK
LITHONIA GA
30038-3291
US

V. Phone/Fax

Practice location:
  • Phone: 330-397-8870
  • Fax:
Mailing address:
  • Phone: 330-397-8870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRANDALYN KEMP
Title or Position: CEO MENTAL HEALTH DIRECTOR
Credential:
Phone: 330-397-8870