Creative Minds for Wellness, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

CSW004354 Issued in GA

Legal business name

CREATIVE MINDS FOR WELLNESS, LLC

Practice address

125 Lee Byrd Rd
Loganville, GA 30052-2310

Phone

(770) 599-7512

NPI assigned

Mar 3, 2018

Organization subpart

Yes

Parent organization

CREATIVE CENTER FOR WELLNESS, INCOORPORATEDAs reported in NPPES

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

Authorized official

Name

Mandy Michelle Miller, LCSW

Title

Coo

Phone

(912) 200-7608

Specialties & licenses 3

Addresses

Part of

Creative Center for Wellness Incorporated

Locations

Practitioners 2

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

• Irene Elizabeth Ferguson, LPC

  • Professional Counselor
  • Lilburn, GA
  • NPI 1326519802
  NPD (past)
• Lawanda Thomas

  • Psychologist
  • Loganville, GA
  • NPI 1194226738
  NPD (past)

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

{
    "created_epoch": "1520035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520035200000",
    "number": "1669974887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4160 LOGAN DR UNIT 3261",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300529531",
            "telephone_number": "770-599-7512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 LEE BYRD RD",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300522310",
            "telephone_number": "770-599-7512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE MINDS FOR WELLNESS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CREATIVE CENTER FOR WELLNESS, INCOORPORATED",
        "enumeration_date": "2018-03-03",
        "last_updated": "2018-03-03",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "MANDY",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "912-200-7608",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "GA",
            "license": "CSW004354",
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristin Cooper
• Desire Core, LPN
• Cornerstone Caregiving East LLC
• Jenene Kae Craig, MBA, OTR/L
• Elissa Ann Crawford Navarrete, LPC
• Creekside Dentistry, LLC
• Anicia Cross-Robinson, DNP, FNP-C, PMHNP-BC
• Crossroads Therapy, LLC
• Michelle Renee Crumbley, NP
• Georgia Cumberbatch

• Mental Health Clinic/Center (Including Community Mental Health Center) in Loganville, GA
• Providers in Loganville, GA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 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.