Anicklette O Crumbley, LPC
Individual provider Active NPI Mental Health Counselor · Pelham, GA
NPI 1225327679 · NPPES record last updated Jun 29, 2026
Key facts
- NPI
- 1225327679
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 188799 (AK)
- Practice address
- 2289 Old Thomasville Rd
Pelham, GA 31779-5832 - Phone
- (678) 499-5669
- NPI assigned
- Apr 6, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2005
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
326 S Mount Auburn Rd
Suite 201
Cape Girardeau, MO 63703-4907
3540 International St
Fairbanks, AK 99701-7382
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260528001464 | AK | Practitioner - Mental Health Counselor | 1254801566 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC006240 | GA | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 188799 | AK | Yes |
| Professional Counselor | 101YP2500X | LPC006240 | GA |
Addresses
Primary practice location
2289 Old Thomasville Rd
Pelham, GA 31779-5832
Mailing address
4002 Highway 78 W Ste 530-112
Snellville, GA 30039-7915
Phone (678) 499-5669
Other providers in Pelham, GA
- Autry State Prison Pharmacy
- Sarah Brooks
- City of Pelham Board of Education
- Jennifer Cromer
- Crumbley Counseling Services LLC
- David B Drury, MD
- Cynthia Parker Drury
- David Brian Drury
- Rebekah Sharon Elliott
- Ryan Taylor Faircloth
All providers in Pelham, GA · Mental Health Counselor in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.