Provider Demographics
NPI:1508327305
Name:CREATING CONSCIOUS CONNECTIONS, LLC
Entity Type:Organization
Organization Name:CREATING CONSCIOUS CONNECTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-956-1056
Mailing Address - Street 1:3315 SOUTH COBB DRIVE
Mailing Address - Street 2:SUITE 700 #813386
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080
Mailing Address - Country:US
Mailing Address - Phone:770-956-1056
Mailing Address - Fax:
Practice Address - Street 1:1827 POWERS FERRY ROAD
Practice Address - Street 2:BUILDING 21 - SUITE 350
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339
Practice Address - Country:US
Practice Address - Phone:770-956-1056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty