Active NPI
Cleo Evans, LPC
- Professional Counselor
- Stone Mountain, GA
National Provider Identifier
1457680704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC007300
- Practice address
- 5638 Manassas Run
Stone Mountain, GA 30087 - Phone
- (470) 262-8351
- NPI assigned
- Dec 16, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC007300 | GA | Primary |
Addresses
Primary practice location
5638 Manassas Run
Stone Mountain, GA 30087
Mailing address
5638 Manassas Run
Stone Mountain, GA 30087
Phone (470) 262-8351
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC007300 | GA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grow Healthcare Group PA | Professional | Current | Accepting new patients |
Locations
66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711
715 Peachtree St NE
Ste 100
Atlanta, GA 30308
Phone (202) 972-4964
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": "1260921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423008000000",
"number": "1457680704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5638 MANASSAS RUN",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "30087",
"telephone_number": "470-262-8351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5638 MANASSAS RUN",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "30087",
"telephone_number": "470-262-8351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "CLEO",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-12-16",
"last_updated": "2015-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC007300",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Stone Mountain, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2015; 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.