Individual provider Active NPI

Samantha Gonzalez, LCSW

  • Mental Health Counselor
  • Tucker, GA
National Provider Identifier
1265164776
Registry record updated Jan 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
2298 Brockett Rd
Tucker, GA 30084-4414
Phone
(706) 425-8900
NPI assigned
Jun 24, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 8, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

2298 Brockett Rd
Tucker, GA 30084-4414

Mailing address

1 Huntington Rd Ste 703
Athens, GA 30606-7214
Phone (706) 425-8900

Other names 1

  • Samantha Nouri Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260205004013 GA Practitioner - Clinical Social Worker 0648759050 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1 Huntington Rd
Suite 703
Athens, GA 30606-7204

862 Heritage Two
Decatur, GA 30033-4103

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Counseling Associates for Well-Being LLC Multi-Specialty CurrentSince Jan 2, 2026 Accepting new patients

Locations

1 Huntington Rd
Ste 703
Athens, GA 30606
Phone 7064258900705

2298 Brockett Rd
Tucker, GA 30084

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1656028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767830400000",
    "number": "1265164776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HUNTINGTON RD STE 703",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306067214",
            "telephone_number": "706-425-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2298 BROCKETT RD",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844414",
            "telephone_number": "706-425-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "SAMANTHA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-24",
        "last_updated": "2026-01-08",
        "certification_date": "2026-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "NOURI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tucker, GA

Sources for this page

Verify at the official NPI Registry.