NPIMap

Organization Active NPI

Cherokee Center for Change Counseling, Inc.

  • Professional Counselor
  • Woodstock, GA
National Provider Identifier
1073892923
Registry record updated Aug 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
2347 Issued in GA
Legal business name
CHEROKEE CENTER FOR CHANGE COUNSELING, INC.
Practice address
409 Old Boring Lane
Woodstock, GA 30189-2495
Phone
(770) 928-7300
Fax
(770) 928-7558
NPI assigned
Aug 10, 2011
Last updated
Aug 10, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2011

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

Authorized official

Name
Mrs. Ita Dore, MS, LPCNPI 1427374255
Title
Director
Phone
(770) 928-7300

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
Professional Counselor 101YP2500X 2347 GA Primary

Addresses

Primary practice location

409 Old Boring Lane
Woodstock, GA 30189-2495

Mailing address

409 Old Boring LN
Woodstock, GA 30189-2495
Phone (770) 928-7300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230323001887 GA Part B Supplier - Clinic/Group Practice 5698149151 Receives reassigned benefits from 3 practitioners
Practice locations: Woodstock, GA

National Provider Directory

National Provider Directory

Locations

409 Old Boring Ln
Woodstock, GA 30189
Phone (770) 928-7300

Practitioners & affiliated clinicians

Practitioners 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1312934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312934400000",
    "number": "1073892923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 OLD BORING LN",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301892495",
            "telephone_number": "770-928-7300",
            "fax_number": "770-928-7558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 OLD BORING LANE",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301892495",
            "telephone_number": "770-928-7300",
            "fax_number": "770-928-7558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHEROKEE CENTER FOR CHANGE COUNSELING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-10",
        "last_updated": "2011-08-10",
        "status": "A",
        "authorized_official_last_name": "DORE",
        "authorized_official_first_name": "ITA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "770-928-7300",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS, LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "2347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodstock, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.