Active NPI
Terris Leigh Hagan
- Mental Health Counselor
- Marietta, GA
National Provider Identifier
1538712302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 1640 Powers Ferry Rd
BLDG 9, Suite 330
Marietta, GA 30067 - Phone
- (404) 482-2334
- NPI assigned
- Jul 22, 2019
- Last updated
- Nov 3, 2022
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
1640 Powers Ferry Rd
BLDG 9, Suite 330
Marietta, GA 30067
Mailing address
1640 Powers Ferry Rd
BLDG 9, Suite 330
Marietta, GA 30067
Phone (404) 482-2334
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 31, 2024 through Jan 31, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667433600000",
"number": "1538712302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1640 POWERS FERRY RD",
"address_2": "BLDG 9, SUITE 330",
"city": "MARIETTA",
"state": "GA",
"postal_code": "30067",
"telephone_number": "404-482-2334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1640 POWERS FERRY RD",
"address_2": "BLDG 9, SUITE 330",
"city": "MARIETTA",
"state": "GA",
"postal_code": "30067",
"telephone_number": "404-482-2334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAGAN",
"first_name": "TERRIS",
"middle_name": "LEIGH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-22",
"last_updated": "2022-11-03",
"certification_date": "2022-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; 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.