Shantaliea Holloway, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC005114 Issued in GA

Practice address

1551 Rose Garden LN
Loganville, GA 30052-2467

Phone

(678) 913-8032

NPI assigned

Sep 6, 2022

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

Specialty

Mental Health Counselor

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Hope 12 12 LLCGroup PAC ID 2062935679, 3 clinicians

Practice addresses (Care Compare)

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.

• Hope 12 12 LLC

  • Professional Counselor
  • Alpharetta, GA
  • NPI 1124879853
  Medicare reassignment Care Compare group NPD
• Vitae Health Medical Georgia LLC

  • Internal Medicine Physician
  • Cartersville, GA
  • NPI 1184320574

  Single Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1662422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1437870771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 648",
            "city": "GRAYSON",
            "state": "GA",
            "postal_code": "300170011",
            "telephone_number": "678-913-8032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 ROSE GARDEN LN",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300522467",
            "telephone_number": "678-913-8032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLOWAY",
        "first_name": "SHANTALIEA",
        "name_prefix": "Ms.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-06",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC005114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria A Hildebrand, NP-C
• Amy E Hill
• Coretta Laureen Hill
• Wanda Nicole Hill, RDH
• Lauren Monteon Holder, MS, RD, LD
• Shala Brandi Holmes
• Honor Thy Mind LLC
• Thomi Hooton
• Diana Marie Hope, M.ED. CCC/SLP
• Hopespring Counseling Services LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.