Active NPI
Jack Underwood, MS, NCC, LPC
- Professional Counselor
- Atlanta, GA
National Provider Identifier
1215373485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC007057
- Practice address
- 3108 Piedmont Rd NE
Atlanta, GA 30305-2513 - Phone
- (404) 421-5341
- NPI assigned
- May 15, 2013
- 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 | LPC007057 | GA | Primary |
Addresses
Primary practice location
3108 Piedmont Rd NE
Atlanta, GA 30305-2513
Mailing address
892 Arlington Dr
Tucker, GA 30084-1567
Phone (404) 421-5341
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC007057 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1368576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368576000000",
"number": "1215373485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "892 ARLINGTON DR",
"city": "TUCKER",
"state": "GA",
"postal_code": "300841567",
"telephone_number": "404-421-5341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3108 PIEDMONT RD NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303052513",
"telephone_number": "404-421-5341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UNDERWOOD",
"first_name": "JACK",
"credential": "MS, NCC, LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-05-15",
"last_updated": "2013-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC007057",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.