NPIMap

Organization Active NPI

A Growth Place, Inc.

  • Marriage & Family Therapist
  • Stockbridge, GA
National Provider Identifier
1073643482
Registry record updated Nov 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MFT000125 Issued in GA
Legal business name
A GROWTH PLACE, INC.
Practice address
10 Wilson Rd
Suite 1
Stockbridge, GA 30281-4433
Phone
(770) 506-9575
Fax
(770) 506-9369
NPI assigned
Mar 6, 2007
Last updated
Nov 30, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2011

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

Authorized official

Name
Mr. Gregory T. Samples, LCSWNPI 1396822664
Title
President
Phone
(770) 506-9575

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MFT000125 GA Primary

Addresses

Primary practice location

10 Wilson Rd
Suite 1
Stockbridge, GA 30281-4433

Mailing address

10 Wilson Rd
Suite 1
Stockbridge, GA 30281-4433
Phone (770) 506-9575

Other identifiers 1

IdentifierTypeStateIssuer
301563086AMedicaidGA

National Provider Directory

National Provider Directory

Locations

10 Wilson Rd
Ste 1
Stockbridge, GA 30281
Phone (770) 506-9575

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322611200000",
    "number": "1073643482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 WILSON RD",
            "address_2": "SUITE 1",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814433",
            "telephone_number": "770-506-9575",
            "fax_number": "770-506-9369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 WILSON RD",
            "address_2": "SUITE 1",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814433",
            "telephone_number": "770-506-9575",
            "fax_number": "770-506-9369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A GROWTH PLACE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2011-11-30",
        "status": "A",
        "authorized_official_last_name": "SAMPLES",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-506-9575",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "GA",
            "license": "MFT000125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "301563086A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockbridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.