Naomi Black, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC-006344 Issued in GA

Practice address

610 Kentucky St
Scottdale, GA 30079-1124

Phone

(470) 206-1262

Fax

(404) 738-2932

NPI assigned

Nov 29, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Circle of Therapeutic Alliance and Consulting, LLC

  • Professional Counselor
  • Stockbridge, GA
  • NPI 1760004758
  NPD (past) Authorized official

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

{
    "created_epoch": "1290988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714348800000",
    "number": "1013219930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "831 SYLVAN PL SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303104938",
            "telephone_number": "404-556-8235",
            "fax_number": "404-738-2932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 KENTUCKY ST",
            "city": "SCOTTDALE",
            "state": "GA",
            "postal_code": "300791124",
            "telephone_number": "470-206-1262",
            "fax_number": "404-738-2932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "NAOMI",
        "name_prefix": "Dr.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-11-29",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "APC-002554",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC-006344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003234513A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Scottdale, GA
• Providers in Scottdale, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2024; 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.