Individual provider Active NPI

Sally J Frostholm, LPC

  • Professional Counselor
  • Augusta, GA
National Provider Identifier
1205924644
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC004342 Issued in GA
Practice address
3421 Mike Padgett Hwy
Augusta, GA 30906-3815
Phone
(706) 432-4858
Fax
(706) 432-3780
NPI assigned
Oct 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 LPC004342 GA Primary

Addresses

Primary practice location

3421 Mike Padgett Hwy
Augusta, GA 30906-3815

Mailing address

3421 Mike Padgett Hwy
Augusta, GA 30906-3815
Phone (706) 432-4858

Other identifiers 1

IdentifierTypeStateIssuer
0000606317BMedicaidGA

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

State licenses

LicenseStateTypeSpecialty
LPC004342GAMDProfessional Counselor

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205924644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 MIKE PADGETT HWY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309063815",
            "telephone_number": "706-432-4858",
            "fax_number": "706-432-3780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3421 MIKE PADGETT HWY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309063815",
            "telephone_number": "706-432-4858",
            "fax_number": "706-432-3780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FROSTHOLM",
        "first_name": "SALLY",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC004342",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000606317B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.