Active NPI
Kimberley Canupp Colluro, LPC
- Professional Counselor
- Braselton, GA
National Provider Identifier
1689646192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC004144
- Practice address
- 26 Charlie Smith Rd
Braselton, GA 30517-2500 - Phone
- (770) 654-6836
- NPI assigned
- Feb 7, 2006
- 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 | LPC004144 | GA | Primary |
Addresses
Primary practice location
26 Charlie Smith Rd
Braselton, GA 30517-2500
Mailing address
5415 Golf View Dr
Braselton, GA 30517-4043
Phone (770) 654-6836
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 |
|---|---|---|---|
| LPC004144 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363737600000",
"number": "1689646192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5415 GOLF VIEW DR",
"city": "BRASELTON",
"state": "GA",
"postal_code": "305174043",
"telephone_number": "770-654-6836"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 CHARLIE SMITH RD",
"city": "BRASELTON",
"state": "GA",
"postal_code": "305172500",
"telephone_number": "770-654-6836"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLLURO",
"first_name": "KIMBERLEY",
"middle_name": "CANUPP",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-02-07",
"last_updated": "2013-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC004144",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Braselton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.