Active NPI
Simiko Stewart-Tianyvu, LPC
- Professional Counselor
- Richmond Hill, GA
National Provider Identifier
1366097776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 007667
- Practice address
- 61 Waverly LN
Richmond Hill, GA 31324-7805 - Phone
- (912) 675-4256
- NPI assigned
- Aug 3, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | C0190 | GA | |
| Professional Counselor | 101YP2500X | 007667 | GA | Primary |
Addresses
Primary practice location
61 Waverly LN
Richmond Hill, GA 31324-7805
Mailing address
61 Waverly LN
Richmond Hill, GA 31324-7805
Phone (404) 312-1522
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C0190 | GA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564790400000",
"number": "1366097776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "61 WAVERLY LN",
"city": "RICHMOND HILL",
"state": "GA",
"postal_code": "313247805",
"telephone_number": "404-312-1522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "61 WAVERLY LN",
"city": "RICHMOND HILL",
"state": "GA",
"postal_code": "313247805",
"telephone_number": "912-675-4256"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEWART-TIANYVU",
"first_name": "SIMIKO",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-03",
"last_updated": "2019-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "GA",
"license": "C0190",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "007667",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond Hill, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.