Active NPI
Camille Antoinett Colson, LPC, CRC
- Professional Counselor
- Tucker, GA
National Provider Identifier
1477044311
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 009941
- Practice address
- 3774 Lavista Rd Ste 100B
Tucker, GA 30084-5618 - Phone
- (404) 909-4100
- NPI assigned
- May 27, 2018
- 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 | 009941 | GA | Primary |
Addresses
Primary practice location
3774 Lavista Rd Ste 100B
Tucker, GA 30084-5618
Mailing address
2890 Georgia Highway 212 SW Ste a-319
Conyers, GA 30094-3363
Phone (404) 610-0343
Other practice location 1
2890 Georgia Highway 212 SW Ste A-319
Conyers, GA 30094-3363
Phone (404) 610-0343
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009941 | GA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Now: New Opportunities Waiting | Professional | Current | Accepting new patients |
Locations
3774 Lavista Rd
Ste 100B
Tucker, GA 30084
Phone (404) 909-4100
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": "1527379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648684800000",
"number": "1477044311",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2890 GEORGIA HIGHWAY 212 SW STE A-319",
"city": "CONYERS",
"state": "GA",
"postal_code": "300943363",
"telephone_number": "404-610-0343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3774 LAVISTA RD STE 100B",
"city": "TUCKER",
"state": "GA",
"postal_code": "300845618",
"telephone_number": "404-909-4100"
}
],
"practiceLocations": [
{
"address_1": "2890 Georgia Highway 212 SW Ste A-319",
"address_purpose": "LOCATION",
"city": "Conyers",
"state": "GA",
"postal_code": "300943363",
"country_code": "US",
"telephone_number": "404-610-0343",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "COLSON",
"first_name": "CAMILLE",
"middle_name": "ANTOINETT",
"credential": "LPC, CRC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-05-27",
"last_updated": "2022-03-31",
"certification_date": "2022-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "009941",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucker, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.