Terri Peterson Sampson, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC011459 Issued in GA

Practice address

175 Gwinnett Dr
Lawrenceville, GA 30046-8444

Phone

(678) 209-2411

Fax

(678) 212-6314

NPI assigned

Nov 27, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1511740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584921600000",
    "number": "1295249449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2103 HICKORY CIR",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300524151",
            "telephone_number": "678-656-9444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 GWINNETT DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468444",
            "telephone_number": "678-209-2411",
            "fax_number": "678-212-6314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPSON",
        "first_name": "TERRI",
        "middle_name": "PETERSON",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-27",
        "last_updated": "2020-03-23",
        "certification_date": "2020-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "73288",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC011459",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "378148601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2020; 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.