Active NPI
Allison Stallworth, LPC
- Professional Counselor
- Evans, GA
National Provider Identifier
1235987355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC014717
- Practice address
- 601 N Belair SQ Ste 3
Evans, GA 30809-4322 - Phone
- (706) 833-0780
- NPI assigned
- May 13, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LPC014717 | GA | |
| Professional Counselor | 101YP2500X | LPC014717 | GA | Primary |
Addresses
Primary practice location
601 N Belair SQ Ste 3
Evans, GA 30809-4322
Mailing address
2140 Vinings LN
Lawrenceville, GA 30043-2862
Phone (678) 634-3042
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 20, 2024 through May 20, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC014717 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715558400000",
"number": "1235987355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2140 VININGS LN",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300432862",
"telephone_number": "678-634-3042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 N BELAIR SQ STE 3",
"city": "EVANS",
"state": "GA",
"postal_code": "308094322",
"telephone_number": "706-833-0780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STALLWORTH",
"first_name": "ALLISON",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-05-13",
"last_updated": "2024-05-13",
"certification_date": "2024-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "GA",
"license": "LPC014717",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC014717",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evans, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2024; 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.