Individual provider Active NPI

Tiffany Pope, LPC, NCC, CPCS

  • Professional Counselor
  • Fairburn, GA
National Provider Identifier
1356792519
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
GA LPC 009013 Issued in GA
Practice address
6303 Foggy Oak Dr
Fairburn, GA 30213-4686
Phone
(706) 231-2008
Fax
(800) 419-9018
NPI assigned
Jun 28, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X GA LPC 009013 GA Primary

Addresses

Primary practice location

6303 Foggy Oak Dr
Fairburn, GA 30213-4686

Mailing address

6303 Foggy Oak Dr
Fairburn, GA 30213-4686
Phone (706) 231-2008

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
I20240214001912 GA Practitioner - Mental Health Counselor 1456795830

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
GA LPC 009013GAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Cultivating R.O.O.T.S., LLC CurrentSince Mar 1, 2020 Accepting new patients

Locations

6045 Atlantic Blvd
Ste 108
Norcross, GA 30071

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": "1467072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1356792519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6303 FOGGY OAK DR",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302134686",
            "telephone_number": "706-231-2008",
            "fax_number": "800-419-9018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6303 FOGGY OAK DR",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302134686",
            "telephone_number": "706-231-2008",
            "fax_number": "800-419-9018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POPE",
        "first_name": "TIFFANY",
        "name_prefix": "Dr.",
        "credential": "LPC, NCC, CPCS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-28",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "GA LPC 009013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairburn, GA

Sources for this page

Verify at the official NPI Registry.