Individual provider Active NPI

Khayla Zaire Smallwood, LPC

  • Professional Counselor
  • Decatur, GA
National Provider Identifier
1104677699
Registry record updated Jan 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC015132 Issued in GA
Practice address
160 Clairemont Ave Ste 400
Decatur, GA 30030-2546
Phone
(404) 500-4266
Fax
(404) 500-4283
NPI assigned
Apr 1, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2026

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 LPC015132 GA Primary

Addresses

Primary practice location

160 Clairemont Ave Ste 400
Decatur, GA 30030-2546

Mailing address

4800 N Scottsdale Rd Ste 2500
Scottsdale, AZ 85251-7630

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20241212002095 GA Practitioner - Mental Health Counselor 8921534009 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Personal Recovery Network LLCGroup PAC ID 5092611384, 612 clinicians

Practice addresses (Care Compare)

160 Clairemont Ave
Suite 400
Decatur, GA 30030-2546
Phone (404) 500-4266

250 Corporate Ctr CT
Stockbridge, GA 30281-6388
Phone (770) 954-8685

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Roy Q Sanders, MD PC CurrentSince Sep 29, 2024 Accepting new patients
Personal Recovery Network LLC Professional CurrentSince Nov 15, 2024 Accepting new patients

Locations

4800 N Scottsdale Rd
Ste 2500
Scottsdale, AZ 85251
Phone (253) 346-0392

160 Clairemont Ave
Ste 445
Decatur, GA 30030
Phone 4045004266 ext. 121

160 Clairemont Ave
Ste 400
Decatur, GA 30030
Phone (404) 500-4266

250 Corporate Center Ct
Stockbridge, GA 30281
Phone (770) 954-8685

Organizations & group practices 2

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": "1711929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767830400000",
    "number": "1104677699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 N SCOTTSDALE RD STE 2500",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852517630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 CLAIREMONT AVE STE 400",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300302546",
            "telephone_number": "404-500-4266",
            "fax_number": "404-500-4283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMALLWOOD",
        "first_name": "KHAYLA",
        "middle_name": "ZAIRE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-01",
        "last_updated": "2026-01-08",
        "certification_date": "2026-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC015132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

Verify at the official NPI Registry.