Connie J Young-Gibraltarik, MED, MA, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC009420 Issued in GA

Practice address

950 Eagles Landing Pkwy
Suite 665
Stockbridge, GA 30281-7343

Phone

(510) 914-7540

Fax

(770) 629-2139

NPI assigned

Feb 21, 2017

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

Enrolled in GA

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.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Iora Senior Health LLCGroup PAC ID 0143520189, 117 clinicians

Iora Health Georgia PCGroup PAC ID 1850644394, 27 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Master of Education

State licenses

Practice roles

Locations

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.

• Iora Health Georgia, P.C.

  • Internal Medicine Physician
  • Tucker, GA
  • NPI 1457846727
  Medicare reassignment Care Compare group NPD
• Iora Senior Health, LLC

  • Internal Medicine Physician
  • Tucker, GA
  • NPI 1518446194
  Medicare reassignment Care Compare group NPD
• New Era Counseling & Educational Services LLC

  • Community/Behavioral Health Agency
  • Stockbridge, GA
  • NPI 1407357270
  NPD Authorized official
• Iora Health Georgia, P.C.

  • Internal Medicine Physician
  • Decatur, GA
  • NPI 1205326881
  NPD
• Iora Senior Health, LLC

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1619376456
  NPD
• Iora Senior Health, LLC

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1659790921
  NPD

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

{
    "created_epoch": "1487635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492905600000",
    "number": "1083153142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 EAGLES LANDING PKWY",
            "address_2": "SUITE 665",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817343",
            "telephone_number": "510-914-7540",
            "fax_number": "770-629-2139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 EAGLES LANDING PKWY",
            "address_2": "SUITE 665",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817343",
            "telephone_number": "510-914-7540",
            "fax_number": "770-629-2139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG-GIBRALTARIK",
        "first_name": "CONNIE",
        "middle_name": "J",
        "credential": "MED, MA, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-02-21",
        "last_updated": "2017-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC009420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tessa Lynn Yarbrough
• Yemmed Healthcare Solutions, Inc
• Minna Jung Yi, PA-C
• Henaku K Yirenkyi, M.D.
• Anaya E Young-El
• Angelique Young, ARNP
• Anisha Young
• Jasmine Young, PT, DPT
• Antonesha Latrice Youngblood
• Elaine C Youngblood, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.