CENTER FOR AUTHENTIC LIFE & RELATIONSHIP, LLC
NPI 1366906778
Clinic/Center - Mental Health (Including Community Mental Health Center) in Kennesaw, GA
About Center For Authentic Life & Relationship, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CENTER FOR AUTHENTIC LIFE & RELATIONSHIP, LLC (NPI 1366906778) is a healthcare organization registered as a mental health (including community mental health center) in Kennesaw, Georgia and active in the NPI registry since January 2019. The organization holds a CLIA Waiver certificate valid through January 13, 2027 and lists Roy Alin Blankenship, Managing Partner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Center For Authentic Life & Relationship, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Center For Authentic Life & Relationship, LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 11D2316892
Center For Authentic Life & Relationship,llc · Kennesaw, GAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Center For Authentic Life & Relationship, LLC's NPI number?
The NPI number for Center For Authentic Life & Relationship, LLC is 1366906778. It was assigned to this organization in the NPPES registry on January 30, 2019.
Where is Center For Authentic Life & Relationship, LLC located?
Center For Authentic Life & Relationship, LLC is located at 1301 Shiloh Rd NW Ste 530, Kennesaw, GA 30144. The listed phone number is (678) 516-6902.
What is Center For Authentic Life & Relationship, LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.
Is Center For Authentic Life & Relationship, LLC enrolled in Medicare?
Yes. Center For Authentic Life & Relationship, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Center For Authentic Life & Relationship, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Mental Health Counselor) reassigns their Medicare billing to Center For Authentic Life & Relationship, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Center For Authentic Life & Relationship, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 11D2316892) is associated with this NPI, valid through January 13, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Center For Authentic Life & Relationship, LLC was last updated on June 4, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Center For Authentic Life & Relationship, Llc · NPI 1366906778
Mental Health (Including Community Mental Health Center) organization in Kennesaw, Georgia. Organization record, active in the CMS NPPES registry since January 30, 2019.
## Identity
- **NPI:** 1366906778 (Entity type: Organization)
- **Enumerated:** January 30, 2019
- **Primary specialty:** Clinic/Center - Mental Health (Including Community Mental Health Center) · taxonomy 261QM0801X
- **Organization subpart:** No
- **Authorized official:** Roy Blankenship, MANAGING PARTNER
## Practice location
- **Address:** 1301 SHILOH RD NW STE 530, Kennesaw, GA 30144-7153
- **Phone:** (678) 516-6902 · **Fax:** (470) 401-1090
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Mental Health Counselor) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 4, 2025
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1366906778) · Data from the CMS NPPES public registry.