Connect Four Counseling LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

CSW004801 Issued in GA

Legal business name

CONNECT FOUR COUNSELING LLC

Practice address

2020 Avalon Pkwy
Suite 375
McDonough, GA 30253-3087

Phone

(678) 833-1664

Fax

(678) 604-8585

NPI assigned

Oct 22, 2015

Last updated

Oct 22, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Shawnette Nichole Miller, LCSWNPI 1790028439

Title

Clinical Social Worker - Therapist

Phone

(678) 833-1664

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shawnette Nichole Miller, LCSW

  • Clinical Social Worker
  • McDonough, GA
  • NPI 1790028439
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1445472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445472000000",
    "number": "1083086581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 AVALON PKWY",
            "address_2": "SUITE 375",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302533087",
            "telephone_number": "678-833-1664",
            "fax_number": "678-604-8585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 AVALON PKWY",
            "address_2": "SUITE 375",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302533087",
            "telephone_number": "678-833-1664",
            "fax_number": "678-604-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECT FOUR COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-22",
        "last_updated": "2015-10-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "SHAWNETTE",
        "authorized_official_middle_name": "NICHOLE",
        "authorized_official_title_or_position": "CLINICAL SOCIAL WORKER - THERAPIST",
        "authorized_official_telephone_number": "678-833-1664",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "CSW004801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003155030A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in McDonough, GA
• Providers in McDonough, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.