Courtney Davis-Persaud

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC013190 Issued in GA

Practice address

307 Anchors Way
Winder, GA 30680-6301

Phone

(706) 633-3467

NPI assigned

May 1, 2024

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

State licenses

Practice roles

Locations

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  GA, Professional

  Medicare reassignment NPD

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

{
    "created_epoch": "1714521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714521600000",
    "number": "1417704131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 ANCHORS WAY",
            "city": "WINDER",
            "state": "GA",
            "postal_code": "306806301",
            "telephone_number": "706-633-3467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 ANCHORS WAY",
            "city": "WINDER",
            "state": "GA",
            "postal_code": "306806301",
            "telephone_number": "706-633-3467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS-PERSAUD",
        "first_name": "COURTNEY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-01",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC013190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Dahlgren
• Ketsia Dajuste
• Ivana Dalton
• Gary Daniels, MD
• Tavarus Dion Daniels, RN
• Raeanne Christine De Melo
• Sarah Marie Della Vecchia, RN, BSN
• Amanda Marie Desimone, APC
• Amy L Deter, MA
• Patricia Dew, ARNP

• Professional Counselor in Winder, GA
• Providers in Winder, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; 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.