John Sullivan, LCSW

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC013465 Issued in GA

Practice address

901 Pavilion CT
McDonough, GA 30253-6665

Phone

(678) 814-4375

NPI assigned

Jan 24, 2023

Last updated

Jan 24, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Mindful Realizations Counseling & Consulting LLC

  • Professional Counselor
  • McDonough, GA
  • NPI 1295164549
  Medicare reassignment NPD

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

{
    "created_epoch": "1674518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674518400000",
    "number": "1275249112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 PAVILION CT",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302536665",
            "telephone_number": "678-814-4375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 PAVILION CT",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302536665",
            "telephone_number": "678-814-4375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JOHN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-24",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC013465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Strength in Care LLC
• Whitney Layne Studle
• Mary Subra, OT
• Successful Dreams Beliefs & Achievements, Inc (Sdba, Inc)
• Successful Dreams Beliefs & Achievements, Inc.
• Kevin Sullivan, MS, LAT, ATC
• Tiffany Lynn Sullivan, LPC
• Brittany C Sumpter, DPM
• Superior Concierge Care,LLC
• Superior Healthcare Services, LLC

• Professional Counselor in McDonough, GA
• Providers in McDonough, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.