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General NPI Number Information
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NPI Number | 1730981713
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Entity Type | Organization
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Legal Business Name | CREATING SUSTAINING JOY LLC
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 5011 OAK TREE LN
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3289
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Country | US
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Telephone | 301-200-2580
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Fax | 240-210-9020
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Provider Business Mailing Address
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Address Line | 1227 ROCKBRIDGE RD. SW STE 208, #364
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3008
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Country | US
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Telephone | 301-200-2580
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Fax | 240-210-9020
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. LANINA ELIZABETH MOMPREMIER
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Credential | PH.D.
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Telephone | 301-683-8858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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