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General NPI Number Information
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NPI Number | 1841779808
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Entity Type | Organization
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Legal Business Name | ESSENTIAL CONNECTIONS, LLC
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Dates
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Enumeration Date | 08/10/2018
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Last Update Date | 01/17/2022
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Provider Practice Location Address
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Address Line | 12700 CENTURY DR UNIT E
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City | ALPHARETTA
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State | GA
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Zip | 30009-8379
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Country | US
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Telephone | 470-202-4852
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Fax | 470-253-1362
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Provider Business Mailing Address
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Address Line | 12700 CENTURY DR UNIT E
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City | ALPHARETTA
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State | GA
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Zip | 30009-8379
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Country | US
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Telephone | 470-202-4852
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Fax | 470-253-1362
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | MRS. LISA MARIE REID
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Credential | LCSW
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Telephone | 470-202-4852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW004984
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License Number State | GA
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