NPIMap

Organization Active NPI

Atlanta Counseling & Diagnotics Center LLC

  • Professional Counselor
  • Lawrenceville, GA
National Provider Identifier
1265825566
Registry record updated Dec 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
007754 Issued in GA
Legal business name
ATLANTA COUNSELING & DIAGNOTICS CENTER LLC
Practice address
2090 Sugarloaf Pkwy Ste 115
Lawrenceville, GA 30045-9402
Phone
(770) 658-4833
NPI assigned
Mar 10, 2015
Last updated
Dec 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2022

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

Authorized official

Name
Mr. Jerrell Walker, LPCNPI 1083017743
Title
Owner/Operater
Phone
(770) 676-0589

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X
Professional Counselor 101YP2500X 007754 GA Primary

Addresses

Primary practice location

2090 Sugarloaf Pkwy Ste 115
Lawrenceville, GA 30045-9402

Mailing address

2090 Sugarloaf Pkwy Ste 115
Lawrenceville, GA 30045-9402
Phone (770) 676-0589

Other identifiers 2

IdentifierTypeStateIssuer
003230686AMedicaidGA
003153183BMedicaidGA

National Provider Directory

National Provider Directory

Locations

3579 Chamblee Tucker Rd
#942446A
Atlanta, GA 30341

2090 Sugarloaf Pkwy
Ste 115
Lawrenceville, GA 30045
Phone (404) 378-2300

2323 Main St
#A3
Tucker, GA 30084

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1425945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671753600000",
    "number": "1265825566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2090 SUGARLOAF PKWY STE 115",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300459402",
            "telephone_number": "770-676-0589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2090 SUGARLOAF PKWY STE 115",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300459402",
            "telephone_number": "770-658-4833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTA COUNSELING & DIAGNOTICS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-10",
        "last_updated": "2022-12-23",
        "certification_date": "2022-12-23",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "JERRELL",
        "authorized_official_title_or_position": "OWNER/OPERATER",
        "authorized_official_telephone_number": "770-676-0589",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "007754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003230686A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003153183B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2022; 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.