Conscious Renewing Therapy

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

CONSCIOUS RENEWING THERAPY

Practice address

3100 Stone Bridge TRL SW
Conyers, GA 30094-6713

Phone

(470) 263-6320

NPI assigned

Nov 29, 2024

Organization subpart

No

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

Authorized official

Name

Mekeya Blake, DSW, LCSWNPI 1871012666

Title

Owner

Phone

(470) 263-6320

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mekeya Blake, LCSW

  • Clinical Social Worker
  • Conyers, GA
  • NPI 1871012666
  NPD Authorized official

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

{
    "created_epoch": "1732838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732838400000",
    "number": "1124844600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3863 HIGHWAY 138 SE # 1379",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814143",
            "telephone_number": "470-263-7264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 STONE BRIDGE TRL SW",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300946713",
            "telephone_number": "470-263-6320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONSCIOUS RENEWING THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-29",
        "last_updated": "2024-11-29",
        "certification_date": "2024-11-29",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "MEKEYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "470-263-6320",
        "authorized_official_credential": "DSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Conyers, GA
• Providers in Conyers, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2024; 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.