Provider Demographics
NPI:1295084317
Name:CREATIVE CONNECTIONS COMPREHENSIVE SERVICES, LLC
Entity type:Organization
Organization Name:CREATIVE CONNECTIONS COMPREHENSIVE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARRON
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-704-2653
Mailing Address - Street 1:PO BOX 495
Mailing Address - Street 2:
Mailing Address - City:AVONDALE EST
Mailing Address - State:GA
Mailing Address - Zip Code:30002-0495
Mailing Address - Country:US
Mailing Address - Phone:404-704-2653
Mailing Address - Fax:404-745-8273
Practice Address - Street 1:798 RAYS RD
Practice Address - Street 2:SUITE 98
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3144
Practice Address - Country:US
Practice Address - Phone:404-704-2653
Practice Address - Fax:404-745-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006271251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health