Active NPI
Jessica Noll
- Marriage & Family Therapist
- Kennesaw, GA
National Provider Identifier
1104462951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFT001545
- Practice address
- 1690 Roberts Blvd NW Ste 109
Kennesaw, GA 30144-7829 - Phone
- (404) 640-2605
- NPI assigned
- Nov 26, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFT001545 | GA | Primary |
Addresses
Primary practice location
1690 Roberts Blvd NW Ste 109
Kennesaw, GA 30144-7829
Mailing address
1836 Roswell St SE Apt 8305
Smyrna, GA 30080-2355
Phone (404) 640-2605
Other practice location 1
4255 Wade Green Rd NW Ste 110
Kennesaw, GA 30144-1762
Phone (404) 640-2605
Other practice location 2
4820 Old Kingston Pike Unit 100
Knoxville, TN 37919-6424
Phone (654) 444-2493
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1850 | Other | TN | TENNESSEE LICENSE |
| MFT001545 | Other | GA | LMFT LICENSE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFT001545 | GA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574726400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616025600000",
"number": "1104462951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1836 ROSWELL ST SE APT 8305",
"city": "SMYRNA",
"state": "GA",
"postal_code": "300802355",
"telephone_number": "404-640-2605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1690 ROBERTS BLVD NW STE 109",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301447829",
"telephone_number": "404-640-2605"
}
],
"practiceLocations": [
{
"address_1": "4255 Wade Green Rd NW Ste 110",
"address_purpose": "LOCATION",
"city": "Kennesaw",
"state": "GA",
"postal_code": "301441762",
"country_code": "US",
"telephone_number": "404-640-2605",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4820 Old Kingston Pike Unit 100",
"address_purpose": "LOCATION",
"city": "Knoxville",
"state": "TN",
"postal_code": "379196424",
"country_code": "US",
"telephone_number": "654-444-2493",
"fax_number": "865-281-3247",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NOLL",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-11-26",
"last_updated": "2021-03-18",
"certification_date": "2020-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "GA",
"license": "MFT001545",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TENNESSEE LICENSE",
"identifier": "1850",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LMFT LICENSE",
"identifier": "MFT001545",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.