Provider Demographics
NPI:1033829882
Name:COMMON EARTHLING
Entity Type:Organization
Organization Name:COMMON EARTHLING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:404-664-6055
Mailing Address - Street 1:3715 NORTHSIDE PARKWAY NW
Mailing Address - Street 2:BUILDING 100-SUITE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327
Mailing Address - Country:US
Mailing Address - Phone:404-793-0924
Mailing Address - Fax:601-568-9733
Practice Address - Street 1:3715 NORTHSIDE PARKWAY NW
Practice Address - Street 2:BUILDING 100-SUITE 500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327
Practice Address - Country:US
Practice Address - Phone:404-793-0924
Practice Address - Fax:601-568-9733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1609544832OtherLMSW