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General NPI Number Information
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NPI Number | 1295084317
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Entity Type | Organization
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Legal Business Name | CREATIVE CONNECTIONS COMPREHENSIVE SERVICES, LLC
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Dates
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Enumeration Date | 09/05/2012
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 798 RAYS RD SUITE 98
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-3144
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Country | US
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Telephone | 404-704-2653
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Fax | 404-745-8273
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Provider Business Mailing Address
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Address Line | PO BOX 495
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City | AVONDALE EST
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State | GA
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Zip | 30002-0495
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Country | US
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Telephone | 404-704-2653
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Fax | 404-745-8273
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MS. SHARRON CROSS
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Credential | LPC
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Telephone | 404-704-2653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health
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License Number | 006271
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License Number State | GA
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