Individual provider Active NPI

Andre McDaniel

  • Addiction (Substance Use Disorder) Counselor
  • College Park, GA
National Provider Identifier
1396092953
Registry record updated Aug 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
GA55492 Issued in GA
Practice address
5524 Old National Hwy
Ste B
College Park, GA 30349-3212
Phone
(404) 763-8555
Fax
(404) 763-8502
NPI assigned
Aug 13, 2012
Last updated
Aug 13, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X GA55492 GA Primary

Addresses

Primary practice location

5524 Old National Hwy
Ste B
College Park, GA 30349-3212

Mailing address

4132 Atlanta Hwy
Ste 110-224
Loganville, GA 30052-4930
Phone (678) 288-6550

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

LicenseStateTypeSpecialty
GA55492GAMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Helping Hands Community Based Services, Inc. Past Accepting new patients
Lillie Cares Health Services, LLC Past Accepting new patients
Gye Nyame Therapeutic Counseling Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344816000000",
    "number": "1396092953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4132 ATLANTA HWY",
            "address_2": "STE 110-224",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300524930",
            "telephone_number": "678-288-6550",
            "fax_number": "678-288-6550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5524 OLD NATIONAL HWY",
            "address_2": "STE B",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303493212",
            "telephone_number": "404-763-8555",
            "fax_number": "404-763-8502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDANIEL",
        "first_name": "ANDRE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-13",
        "last_updated": "2012-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "GA",
            "license": "GA55492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in College Park, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; 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.