Individual provider Active NPI

Charlett Theresa Harris, LPC012133

  • Professional Counselor
  • Marietta, GA
National Provider Identifier
1720660855
Registry record updated Sep 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC012133 Issued in GA
Practice address
3911 Mary Eliza Trce NW Ste 200
Marietta, GA 30064-1088
Phone
(678) 631-9907
NPI assigned
Apr 27, 2021
Last updated
Sep 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X LPC012133 GA Primary

Addresses

Primary practice location

3911 Mary Eliza Trce NW Ste 200
Marietta, GA 30064-1088

Mailing address

3911 Mary Eliza Trce NW Ste 200
Marietta, GA 30064-1088
Phone (678) 631-9907

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240130002734 GA Practitioner - Mental Health Counselor 5193119576 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Mercer University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Charnat LLCGroup PAC ID 1153774799, 2 clinicians

Practice addresses (Care Compare)

3911 Mary Eliza Trce NW
Suite 200
Marietta, GA 30064-1088
Phone (678) 631-9907

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Charnat LLC Single Specialty CurrentSince Jan 1, 2024 Accepting new patients

Locations

2487 Cedarcrest Rd
Ste 722
Acworth, GA 30101
Phone (678) 629-0957

3911 Mary Eliza Trce NW
Ste 200
Marietta, GA 30064
Phone (678) 384-3480

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1619481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1720660855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3911 MARY ELIZA TRCE NW STE 200",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300641088",
            "telephone_number": "678-631-9907",
            "fax_number": "678-701-7909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3911 MARY ELIZA TRCE NW STE 200",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300641088",
            "telephone_number": "678-631-9907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "CHARLETT",
        "middle_name": "THERESA",
        "name_prefix": "Mrs.",
        "credential": "LPC012133",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-27",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC012133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.