| Creative Center For Wellness, Incorporated | |
|
204 W Spring St Monroe GA 30655-1914 | |
| (707) 599-7508 | |
| (866) 734-7631 |
| Full Name | Creative Center For Wellness, Incorporated |
|---|---|
| Speciality | Social Worker |
| Location | 204 W Spring St, Monroe, Georgia |
| Authorized Official Name and Position | Mandy Michelle Miller (CEO) |
| Authorized Official Contact | 7705997508 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creative Center For Wellness, Incorporated 204 W Spring St Monroe GA 30655-1914 Ph: (707) 599-7508 | Creative Center For Wellness, Incorporated 204 W Spring St Monroe GA 30655-1914 Ph: (707) 599-7508 |
| NPI Number | 1154837946 |
|---|---|
| Provider Enumeration Date | 12/16/2017 |
| Last Update Date | 03/14/2024 |
| Certification Date | 03/14/2024 |
| Medicare PECOS PAC ID | 3274888946 |
|---|---|
| Medicare Enrollment ID | O20180620002529 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154837946 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | CSW004354 (Georgia) | Primary |
| Provider Name | Mandy Michelle Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669745642 PECOS PAC ID: 5597926022 Enrollment ID: I20120410000681 |
| Provider Name | Jegnasha Patel |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1134650195 PECOS PAC ID: 6608278619 Enrollment ID: I20210714000448 |
| Provider Name | Richard Lee Phillips |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487819207 PECOS PAC ID: 5991108607 Enrollment ID: I20210719002105 |
| Provider Name | Ashlyn Tatiana Virginia Mcallister |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861128308 PECOS PAC ID: 3577930247 Enrollment ID: I20221109001722 |
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