Beaufort Addison III

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

5576 Oak Bend PL
Lithonia, GA 30058-3302

Phone

(803) 664-4007

NPI assigned

Mar 25, 2021

Last updated

Mar 25, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rising Hope Clinical Assistance, LLC

  dba A New Way of Life

  • Community/Behavioral Health Agency
  • Columbus, OH
  • NPI 1669896130
  NPD (past)

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

{
    "created_epoch": "1616630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1205413481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5576 OAK BEND PL",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300583302",
            "telephone_number": "803-664-4007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5576 OAK BEND PL",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300583302",
            "telephone_number": "803-664-4007"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 S 3rd St",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432154206",
            "country_code": "US",
            "telephone_number": "614-726-1485",
            "fax_number": "866-416-1767",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1755 The Exchange SE Ste 330U",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303397434",
            "country_code": "US",
            "telephone_number": "678-273-3005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADDISON",
        "first_name": "BEAUFORT",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-25",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://sharenote.com",
            "affiliation": "Y",
            "affiliationName": "Rising Hope Clinical Assistance, LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1755 The Exchange SE Ste 330U",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303397434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Counselor in Lithonia, GA
• Providers in Lithonia, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2021; 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.