Active NPI
Kim Brooks
- Professional Counselor
- Lawrenceville, GA
National Provider Identifier
1053795989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC004369
- Practice address
- 220 W Crogan St
Ste a
Lawrenceville, GA 30046-3238 - Phone
- (678) 386-1895
- Fax
- (678) 623-8300
- NPI assigned
- Jul 9, 2015
- Last updated
- Jul 9, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 | LPC004369 | GA | Primary |
Addresses
Primary practice location
220 W Crogan St
Ste a
Lawrenceville, GA 30046-3238
Mailing address
PO Box 1654
Lawrenceville, GA 30046-1654
Phone (678) 386-1895
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 |
|---|---|---|---|
| LPC004369 | GA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gwinnett Comprehensive Counseling LLC | Professional | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Professional Counselor
- Lawrenceville, GA
- NPI 1720461973
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1436400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436400000000",
"number": "1053795989",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1654",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300461654",
"telephone_number": "678-386-1895",
"fax_number": "678-623-8300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 W CROGAN ST",
"address_2": "STE A",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300463238",
"telephone_number": "678-386-1895",
"fax_number": "678-623-8300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOKS",
"first_name": "KIM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-07-09",
"last_updated": "2015-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC004369",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.