NPIMap

Individual provider Active NPI

Jeri Sansom Green, MS, LPC

  • Professional Counselor
  • Suwanee, GA
National Provider Identifier
1073818845
Registry record updated Jan 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC004176 Issued in GA
Practice address
5400 Laurel Springs Pkwy Ste 602
Suwanee, GA 30024-6067
Phone
(678) 213-2194
NPI assigned
Jan 25, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LPC004176 GA Primary

Addresses

Primary practice location

5400 Laurel Springs Pkwy Ste 602
Suwanee, GA 30024-6067

Mailing address

5400 Laurel Springs Pkwy Ste 602
Suwanee, GA 30024-6067
Phone (678) 213-2194

Other names 1

  • Jeri Dawn Sansom Former name

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
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
LPC004176GAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Ray of Hope Counseling Services, Inc 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1295913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295913600000",
    "number": "1073818845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 LAUREL SPRINGS PKWY STE 602",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246067",
            "telephone_number": "678-213-2194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 LAUREL SPRINGS PKWY STE 602",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246067",
            "telephone_number": "678-213-2194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "JERI",
        "middle_name": "SANSOM",
        "credential": "MS, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-25",
        "last_updated": "2011-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC004176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JERI",
            "last_name": "SANSOM",
            "middle_name": "DAWN",
            "credential": "MS, LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Suwanee, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.