Active NPI
Nadya Clontz, LAPC
- Counselor
- Suwanee, GA
National Provider Identifier
1710517073
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- APC006803
- Practice address
- 4411 Suwanee Dam Rd Ste 450
Suwanee, GA 30024-8706 - Phone
- (770) 331-6592
- NPI assigned
- Jan 24, 2020
- Last updated
- Jan 24, 2020
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | APC006803 | GA | Primary |
Addresses
Primary practice location
4411 Suwanee Dam Rd Ste 450
Suwanee, GA 30024-8706
Mailing address
801 Old Peachtree Rd NW Unit 24
Lawrenceville, GA 30043-3316
Phone (770) 883-8768
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 2, 2024 through May 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APC006803 | GA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579824000000",
"number": "1710517073",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 OLD PEACHTREE RD NW UNIT 24",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300433316",
"telephone_number": "770-883-8768"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4411 SUWANEE DAM RD STE 450",
"city": "SUWANEE",
"state": "GA",
"postal_code": "300248706",
"telephone_number": "770-331-6592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLONTZ",
"first_name": "NADYA",
"credential": "LAPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-24",
"last_updated": "2020-01-24",
"certification_date": "2020-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "GA",
"license": "APC006803",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Suwanee, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2020; 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.