Active NPI
Carolyn Rose Tucker, LPC
- Professional Counselor
- Conyers, GA
National Provider Identifier
1053688143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC007670
- Practice address
- 1009 Milstead Ave NE Ste 210
Conyers, GA 30012-4510 - Phone
- (770) 789-0847
- NPI assigned
- Nov 17, 2011
- Sex
- Female
- 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 | LPC007670 | GA | Primary |
Addresses
Primary practice location
1009 Milstead Ave NE Ste 210
Conyers, GA 30012-4510
Mailing address
2424 Santa Barbra CT SE
Conyers, GA 30013-2006
Phone (770) 789-0847
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC007670 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1390867200000",
"number": "1053688143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2424 SANTA BARBRA CT SE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300132006",
"telephone_number": "770-789-0847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1009 MILSTEAD AVE NE STE 210",
"city": "CONYERS",
"state": "GA",
"postal_code": "300124510",
"telephone_number": "770-789-0847"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUCKER",
"first_name": "CAROLYN",
"middle_name": "ROSE",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-17",
"last_updated": "2014-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC007670",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conyers, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.