NPIMap

Organization Active NPI

Quinnise Pettway, LPC, NCC

  • Professional Counselor
  • Roswell, GA
National Provider Identifier
1144512591
Registry record updated May 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC006121 Issued in GA
Legal business name
QUINNISE PETTWAY, LPC, NCC
Practice address
490 Sun Valley Dr
Suite 205
Roswell, GA 30076-5615
Phone
(770) 642-4236
NPI assigned
May 4, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Quinnise Pettway, LPC, NCC
Title
Owner/President
Phone
(770) 642-4236

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X LPC006121 GA Primary

Addresses

Primary practice location

490 Sun Valley Dr
Suite 205
Roswell, GA 30076-5615

Mailing address

490 Sun Valley Dr
Suite 205
Roswell, GA 30076-5615
Phone (770) 642-4236

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1304467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304467200000",
    "number": "1144512591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "490 SUN VALLEY DR",
            "address_2": "SUITE 205",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765615",
            "telephone_number": "770-642-4236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 SUN VALLEY DR",
            "address_2": "SUITE 205",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765615",
            "telephone_number": "770-642-4236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUINNISE PETTWAY, LPC, NCC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-04",
        "last_updated": "2011-05-04",
        "status": "A",
        "authorized_official_last_name": "PETTWAY",
        "authorized_official_first_name": "QUINNISE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "770-642-4236",
        "authorized_official_credential": "LPC, NCC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC006121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.