Individual provider Active NPI

Jacqueline Denise Roberts, LPC

  • Professional Counselor
  • Alpharetta, GA
National Provider Identifier
1407593254
Registry record updated May 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC014198 Issued in GA
Practice address
5480 McGinnis Village PL Ste 104
Alpharetta, GA 30005-1746
Phone
(678) 213-2194
NPI assigned
May 13, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LPC014198 GA
Professional Counselor 101YP2500X LPC014198 GA Primary

Addresses

Primary practice location

5480 McGinnis Village PL Ste 104
Alpharetta, GA 30005-1746

Mailing address

3925 Frasier Dr
Cumming, GA 30028-4142
Phone (214) 984-8057

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LPC014198GAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Personal Recovery Network LLC Professional PastSince May 16, 2022 Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1652400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747180800000",
    "number": "1407593254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3925 FRASIER DR",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300284142",
            "telephone_number": "214-984-8057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5480 MCGINNIS VILLAGE PL STE 104",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300051746",
            "telephone_number": "678-213-2194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JACQUELINE",
        "middle_name": "DENISE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-13",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "LPC014198",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC014198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alpharetta, GA

Sources for this page

Verify at the official NPI Registry.