Active NPI
Jennifer Carlson, LPC
- Professional Counselor
- Marietta, GA
National Provider Identifier
1194299933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC010544
- Practice address
- 1640 Powers Ferry Rd SE
Building 2 Ste 150
Marietta, GA 30067 - Phone
- (770) 726-9624
- NPI assigned
- Jan 15, 2019
- Sex
- Female
- 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 | LPC010544 | GA | Primary |
Addresses
Primary practice location
1640 Powers Ferry Rd SE
Building 2 Ste 150
Marietta, GA 30067
Mailing address
1640 Powers Ferry Rd SE
Building 2 Ste 150
Marietta, GA 30067
Phone (770) 726-9624
Other practice location 1
9810 Medlock Bridge Road
Building B Suite 101
Johns Creek, GA 30097
Phone (770) 680-4732
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 7, 2024 through Feb 7, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC010544 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547510400000",
"number": "1194299933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1640 POWERS FERRY RD SE",
"address_2": "BUILDING 2 STE 150",
"city": "MARIETTA",
"state": "GA",
"postal_code": "30067",
"telephone_number": "770-726-9624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1640 POWERS FERRY RD SE",
"address_2": "BUILDING 2 STE 150",
"city": "MARIETTA",
"state": "GA",
"postal_code": "30067",
"telephone_number": "770-726-9624"
}
],
"practiceLocations": [
{
"address_1": "9810 Medlock Bridge Road",
"address_2": "Building B Suite 101",
"address_purpose": "LOCATION",
"city": "Johns Creek",
"state": "GA",
"postal_code": "30097",
"country_code": "US",
"telephone_number": "770-680-4732",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CARLSON",
"first_name": "JENNIFER",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-15",
"last_updated": "2019-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC010544",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.