Enricka Victoria Maddox, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC008094 Issued in GA

Practice address

1500 Klondike Rd SW Ste A103
Conyers, GA 30094-5115

Phone

(770) 609-1936

NPI assigned

Sep 7, 2021

Last updated

Sep 7, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1630972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630972800000",
    "number": "1073281804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 TABOR TRCE",
            "city": "OXFORD",
            "state": "GA",
            "postal_code": "300544049",
            "telephone_number": "404-453-3680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 KLONDIKE RD SW STE A103",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300945115",
            "telephone_number": "770-609-1936"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "45 Tabor Trce",
            "address_purpose": "LOCATION",
            "city": "Oxford",
            "state": "GA",
            "postal_code": "300544049",
            "country_code": "US",
            "telephone_number": "404-453-3680",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MADDOX",
        "first_name": "ENRICKA",
        "middle_name": "VICTORIA",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-07",
        "last_updated": "2021-09-07",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC008094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.