Active NPI
Christie Poole, MFT
- Professional Counselor
- Woodstock, GA
National Provider Identifier
1043619794
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- MFT001275
- Practice address
- 4595 Towne Lake Pkwy
Building 300 Suite 250
Woodstock, GA 30189-5514 - Phone
- (678) 631-7639
- NPI assigned
- Aug 19, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | MFT001275 | GA | Primary |
Addresses
Primary practice location
4595 Towne Lake Pkwy
Building 300 Suite 250
Woodstock, GA 30189-5514
Mailing address
4595 Towne Lake Pkwy
Building 300 Suite 250
Woodstock, GA 30189-5514
Phone (678) 631-7639
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFT001275 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469577600000",
"number": "1043619794",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4595 TOWNE LAKE PKWY",
"address_2": "BUILDING 300 SUITE 250",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301895514",
"telephone_number": "678-631-7639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4595 TOWNE LAKE PKWY",
"address_2": "BUILDING 300 SUITE 250",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301895514",
"telephone_number": "678-631-7639"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POOLE",
"first_name": "CHRISTIE",
"credential": "MFT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-08-19",
"last_updated": "2016-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "MFT001275",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodstock, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.