Active NPI
Samson Teklemariam, LPC
- Professional Counselor
- Woodstock, GA
National Provider Identifier
1699907501
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 5606
- Practice address
- 210 Emerson Heights Dr
Woodstock, GA 30188-2522 - Phone
- (678) 551-0287
- NPI assigned
- Aug 12, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 5606 | SC | Primary |
| Mental Health Counselor | 101YM0800X |
Addresses
Primary practice location
210 Emerson Heights Dr
Woodstock, GA 30188-2522
Mailing address
210 Emerson Heights Dr
Woodstock, GA 30188-2522
Phone (678) 551-0287
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3000641104 | Other | SC | WORKER'S COMP |
| 322842 | Medicaid | SC |
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 |
|---|---|---|---|
| 5606 | SC | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Carolina Dept of Mental Health Accounting Office | Single Specialty | Past | Accepting new patients |
| Lexington County Community Mental Health Center | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Community/Behavioral Health Agency
- Lexington, SC
- NPI 1639411911
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Lexington, SC
- NPI 1841374972
Single Specialty
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1250035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716163200000",
"number": "1699907501",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 EMERSON HEIGHTS DR",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301882522",
"telephone_number": "678-551-0287"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 EMERSON HEIGHTS DR",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301882522",
"telephone_number": "678-551-0287"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEKLEMARIAM",
"first_name": "SAMSON",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-08-12",
"last_updated": "2024-05-20",
"certification_date": "2024-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": "SC",
"license": "5606",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WORKER'S COMP",
"identifier": "3000641104",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "322842",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodstock, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.