NPIMap

Organization Active NPI

Creative Center for Wellness, Incorporated

  • Clinical Social Worker
  • Monroe, GA
National Provider Identifier
1154837946
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW004354 Issued in GA
Legal business name
CREATIVE CENTER FOR WELLNESS, INCORPORATED
Practice address
204 W Spring St
Monroe, GA 30655-1914
Phone
(707) 599-7508
Fax
(866) 734-7631
NPI assigned
Dec 16, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2025

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

Authorized official

Name
Mandy Michelle Miller, LCSWNPI 1669745642
Title
Ceo
Phone
(770) 599-7508

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X CSW004354 GA Primary

Addresses

Primary practice location

204 W Spring St
Monroe, GA 30655-1914

Mailing address

204 W Spring St
Monroe, GA 30655-1914
Phone (707) 599-7508

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180620002529 GA Part B Supplier - Clinic/Group Practice 3274888946 Receives reassigned benefits from 4 practitioners
Practice locations: Loganville, GA

National Provider Directory

National Provider Directory

Locations

204 W Spring St
Monroe, GA 30655
Phone (707) 599-7508

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1513382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744156800000",
    "number": "1154837946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 W SPRING ST",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306551914",
            "telephone_number": "707-599-7508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 W SPRING ST",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306551914",
            "telephone_number": "707-599-7508",
            "fax_number": "866-734-7631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE CENTER FOR WELLNESS, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-16",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "MANDY",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-599-7508",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW004354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.