Amber J Illum, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC004396 Issued in GA

Practice address

3455 Lawrenceville Suwanee Rd Ste a
Suwanee, GA 30024-6425

Phone

(770) 932-2899

Fax

(770) 932-2895

NPI assigned

Mar 9, 2007

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 9, 2024 through Jan 9, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• North Gwinnett Counseling Associates, LLC

  • Mental Health Counselor
  • Suwanee, GA
  • NPI 1629314349
  NPD (past)

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359331200000",
    "number": "1497886378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3455 LAWRENCEVILLE SUWANEE RD STE A",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246425",
            "telephone_number": "770-932-2899",
            "fax_number": "770-932-2895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 LAWRENCEVILLE SUWANEE RD STE A",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246425",
            "telephone_number": "770-932-2899",
            "fax_number": "770-932-2895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILLUM",
        "first_name": "AMBER",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-09",
        "last_updated": "2013-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC004396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.