Create It Kids Club, LLC.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

CREATE IT KIDS CLUB, LLC.

Practice address

1425 Market Blvd Ste 530-251
Roswell, GA 30076-6708

Phone

(678) 235-4333

NPI assigned

May 29, 2018

Organization subpart

No

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

Authorized official

Name

Tameka Anderson

Title

Behavior Specialist

Phone

(678) 235-4333

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1527552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527552000000",
    "number": "1518458249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 MARKET BLVD STE 530-251",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300766708",
            "telephone_number": "678-235-4333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 MARKET BLVD STE 530-251",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300766708",
            "telephone_number": "678-235-4333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATE IT KIDS CLUB, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-29",
        "last_updated": "2018-05-29",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "TAMEKA",
        "authorized_official_title_or_position": "BEHAVIOR SPECIALIST",
        "authorized_official_telephone_number": "678-235-4333"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385HR2050X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care Camp",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Roswell, GA
• Providers in Roswell, 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 May 29, 2018; 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.