MEDICARE: CONSCIOUS LIVING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1558225508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSCIOUS LIVING LLC

Provider Business Mailing Address
First Line	:	3517 STONELEIGH WALK
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30038-3291
Country	:	US
Telephone Number	:	330-397-8870
Fax Number	:

Provider Business Practice Location Address
First Line	:	3517 STONELEIGH WALK
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30038-3291
Country	:	US
Telephone Number	:	330-397-8870
Fax Number	:

Authorized Official
Title or Position	:	CEO MENTAL HEALTH DIRECTOR
Name	:	BRANDALYN KEMP
Credential	:
Telephone Number	:	330-397-8870

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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Directions to “CONSCIOUS LIVING LLC ” Practice Location

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