Ellyce Diana Payne, MS, NCC, LAPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

005656 Issued in GA

Practice address

6095 Pine Mountain Rd NW Ste 105
Kennesaw, GA 30152-3332

Phone

(678) 217-7529

Fax

(770) 966-8228

NPI assigned

May 30, 2017

Sex

Female

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

Credentials

Master of Science

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

{
    "created_epoch": "1496102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496102400000",
    "number": "1366970782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2743 FAIRFIELD DR SW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300643721",
            "telephone_number": "678-522-7832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6095 PINE MOUNTAIN RD NW STE 105",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301523332",
            "telephone_number": "678-217-7529",
            "fax_number": "770-966-8228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAYNE",
        "first_name": "ELLYCE",
        "middle_name": "DIANA",
        "credential": "MS, NCC, LAPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-30",
        "last_updated": "2017-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "005656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Breyanna Patterson
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• Indya Patterson
• Raymond Allen Patterson, PHARMD
• Paw and Peace Mental Health Counseling LLC
• Peacemaker Solutions, Inc.
• Peach Seed Healthcare
• Peachtree Health Group LLC
• Marilyn Diane Pearce, LMFT, PH.D.
• Neal P. Pearce, P.T.

• Mental Health Counselor in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2017; 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.