Individual provider Active NPI

Aderinola Aiyeola

  • Professional Counselor
  • Stone Mountain, GA
National Provider Identifier
1396347803
Registry record updated Mar 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC011770 Issued in GA
Practice address
1468 Cheyenne CT
Stone Mountain, GA 30087-3101
Phone
(678) 468-5090
NPI assigned
Nov 10, 2020
Last updated
Mar 20, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 20, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X
Professional Counselor 101YP2500X LPC011770 GA Primary

Addresses

Primary practice location

1468 Cheyenne CT
Stone Mountain, GA 30087-3101

Mailing address

3348 Peachtree Rd NE Ste 700
Atlanta, GA 30326-1682
Phone (678) 468-5090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20231229000561 TX Practitioner - Mental Health Counselor 3577913797 Reassigns benefits to 1 organization
I20240402002610 GA Practitioner - Mental Health Counselor 3577913797 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sondermind Provider Network LLCGroup PAC ID 9537572490, 1,295 clinicians

Practice addresses (Care Compare)

2021 Guadalupe St
Suite 260
Austin, TX 78705-5654
Phone (866) 630-0966

3372 Peachtree Rd NE
Suite 115
Atlanta, GA 30326-1963
Phone (866) 630-0966

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Teladoc Health Medical Group, P.a. Professional Current Accepting new patients
Sondermind Provider Network LLC Professional CurrentSince Jan 1, 2024 Accepting new patients

Locations

3348 Peachtree Rd NE
Ste 700
Atlanta, GA 30326
Phone (720) 712-7900

2021 Guadalupe St
Ste 260
Austin, TX 78705
Phone (202) 932-9958

Interoperability endpoints

  • Direct secure messaging: aderinolaaiyeolascott@tdh.allscriptsdirect.net

Organizations & group practices 2

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": "1604966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710892800000",
    "number": "1396347803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3348 PEACHTREE RD NE STE 700",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303261682",
            "telephone_number": "678-468-5090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1468 CHEYENNE CT",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873101",
            "telephone_number": "678-468-5090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AIYEOLA",
        "first_name": "ADERINOLA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-10",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC011770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stone Mountain, GA

Sources for this page

Verify at the official NPI Registry.