Active NPI
Charles Greg Malone
- Professional Counselor
- Dacula, GA
National Provider Identifier
1124941299
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC016490
- Practice address
- 2155 Enclave Mill Dr
Dacula, GA 30019-3290 - Phone
- (404) 276-1578
- NPI assigned
- Aug 4, 2026
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC016490 | GA | Primary |
Addresses
Primary practice location
2155 Enclave Mill Dr
Dacula, GA 30019-3290
Mailing address
2155 Enclave Mill Dr
Dacula, GA 30019-3290
Phone (404) 276-1578
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1785801600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785801600000",
"number": "1124941299",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2155 ENCLAVE MILL DR",
"city": "DACULA",
"state": "GA",
"postal_code": "300193290",
"telephone_number": "404-276-1578"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2155 ENCLAVE MILL DR",
"city": "DACULA",
"state": "GA",
"postal_code": "300193290",
"telephone_number": "404-276-1578"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALONE",
"first_name": "CHARLES",
"middle_name": "GREG",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-08-04",
"last_updated": "2026-08-04",
"certification_date": "2026-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC016490",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dacula, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.