Active NPI
Richard Brent Wadsworth Jr., LAPC
- Mental Health Counselor
- Villa Rica, GA
National Provider Identifier
1104531599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- APC005998
- Practice address
- 101 Quartz Dr Ste 201
Villa Rica, GA 30180-3256 - Phone
- (770) 812-3839
- NPI assigned
- Jan 19, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | APC005998 | GA | Primary |
Addresses
Primary practice location
101 Quartz Dr Ste 201
Villa Rica, GA 30180-3256
Mailing address
2022 Dartmoth Way
Villa Rica, GA 30180-5860
Phone (404) 829-9722
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17844 | Medicaid | GA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | rwadsworth@tanner.com | Other |
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 |
|---|---|---|---|
| APC005998 | GA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674086400000",
"number": "1104531599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2022 DARTMOTH WAY",
"city": "VILLA RICA",
"state": "GA",
"postal_code": "301805860",
"telephone_number": "404-829-9722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 QUARTZ DR STE 201",
"city": "VILLA RICA",
"state": "GA",
"postal_code": "301803256",
"telephone_number": "770-812-3839"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADSWORTH",
"first_name": "RICHARD",
"middle_name": "BRENT",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "LAPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-01-19",
"last_updated": "2023-01-19",
"certification_date": "2023-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "GA",
"license": "APC005998",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "17844",
"state": "GA"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "rwadsworth@tanner.com",
"affiliation": "N",
"endpointDescription": "this is my Tanner email",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "contacting colleges",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "schedualing and using encrypted programs to input patients",
"address_1": "101 Quartz Dr Ste 201",
"city": "Villa Rica",
"state": "GA",
"country_code": "US",
"postal_code": "301803256",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Villa Rica, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.