Active NPI
Elise Carlson, LPC
- Professional Counselor
- Atlanta, GA
National Provider Identifier
1710311055
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 007021
- Practice address
- 1017 Fayetteville Rd SE
A
Atlanta, GA 30316-2936 - Phone
- (404) 324-4190
- Fax
- (404) 324-4191
- NPI assigned
- Aug 22, 2013
- 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 | 007021 | GA | Primary |
Addresses
Primary practice location
1017 Fayetteville Rd SE
A
Atlanta, GA 30316-2936
Mailing address
1017 Fayetteville Rd SE
A
Atlanta, GA 30316-2936
Phone (404) 324-4190
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 640804505E | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 7, 2024 through Feb 7, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007021 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377129600000",
"number": "1710311055",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1017 FAYETTEVILLE RD SE",
"address_2": "A",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303162936",
"telephone_number": "404-324-4190",
"fax_number": "404-324-4191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1017 FAYETTEVILLE RD SE",
"address_2": "A",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303162936",
"telephone_number": "404-324-4190",
"fax_number": "404-324-4191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "ELISE",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-22",
"last_updated": "2013-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "007021",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "640804505E",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.