Individual provider Active NPI

Kristi Spence Sullivan, LCSW

  • Clinical Social Worker
  • Marietta, GA
National Provider Identifier
1598020398
Registry record updated Jul 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW003884 Issued in GA
Practice address
2940 Johnson Ferry Rd Ste B-127
Marietta, GA 30062-8361
Phone
(678) 637-7166
NPI assigned
Jul 8, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X CSW003884 GA Primary

Addresses

Primary practice location

2940 Johnson Ferry Rd Ste B-127
Marietta, GA 30062-8361

Mailing address

2940 Johnson Ferry Rd Ste B-127
Marietta, GA 30062-8361
Phone (678) 637-7166

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120910000841 GA Practitioner - Clinical Social Worker 7416105861 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mindful Transitions, LLCGroup PAC ID 7911083365, 8 clinicians

Practice addresses (Care Compare)

2940 Johnson Ferry Rd
Suite B 127
Marietta, GA 30062-8361
Phone (678) 637-7166

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1341705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721260800000",
    "number": "1598020398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2940 JOHNSON FERRY RD STE B-127",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300628361",
            "telephone_number": "678-637-7166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2940 JOHNSON FERRY RD STE B-127",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300628361",
            "telephone_number": "678-637-7166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KRISTI",
        "middle_name": "SPENCE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-08",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW003884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.