Southeast Perinatal Counseling LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

SOUTHEAST PERINATAL COUNSELING LLC

Practice address

1450 Newnan Crossing Blvd E Apt 4213
Newnan, GA 30265-0010

Phone

(678) 404-9886

NPI assigned

Sep 28, 2020

Organization subpart

No

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

Authorized official

Name

Crystal Wilson, LCSWNPI 1598237885

Title

Therapist

Phone

(678) 404-9886

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Crystal Marie Wilson, LCSW

  • Clinical Social Worker
  • Newnan, GA
  • NPI 1598237885
  NPD Authorized official

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

{
    "created_epoch": "1601251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601251200000",
    "number": "1376150870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "388 BULLSBORO DR # 301",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302631069",
            "telephone_number": "678-404-9886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 NEWNAN CROSSING BLVD E APT 4213",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302650010",
            "telephone_number": "678-404-9886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST PERINATAL COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-28",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "678-404-9886",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "simplepratice.com",
            "affiliation": "N",
            "endpointDescription": "HIPAA compliant secure site for documentation , exchange with client, and virtual therapy",
            "address_1": "1450 Newnan Crossing Blvd E Apt 4213",
            "city": "Newnan",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302650010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinical Social Worker in Newnan, GA
• Providers in Newnan, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.