Active NPI
Courtney Willis
- Counselor
- Union City, GA
National Provider Identifier
1073013298
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- LPC013142
- Practice address
- 108 Mumsford CT
Union City, GA 30291-3471 - Phone
- (404) 642-7565
- NPI assigned
- Feb 14, 2018
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | LPC013142 | GA | Primary |
Addresses
Primary practice location
108 Mumsford CT
Union City, GA 30291-3471
Mailing address
108 Mumsford CT
Union City, GA 30291-3471
Phone (404) 642-7565
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 |
|---|---|---|---|
| LPC013142 | GA | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dekalb Community Service Board | Past | Accepting new patients | |
| Dekalb Community Service Board | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Community/Behavioral Health Agency
- Decatur, GA
- NPI 1073686978
-
- Community/Behavioral Health Agency
- Decatur, GA
- NPI 1134264179
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1518566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681862400000",
"number": "1073013298",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 MUMSFORD CT",
"city": "UNION CITY",
"state": "GA",
"postal_code": "302913471",
"telephone_number": "404-642-7565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 MUMSFORD CT",
"city": "UNION CITY",
"state": "GA",
"postal_code": "302913471",
"telephone_number": "404-642-7565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "COURTNEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-14",
"last_updated": "2023-04-19",
"certification_date": "2023-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "GA",
"license": "LPC013142",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Union City, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.