Active NPI
Kayla Lustosa
- Mental Health Counselor
- Buford, GA
National Provider Identifier
1720853377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LPC015492
- Practice address
- 2675 Mall of Georgia Blvd Ste 102
Buford, GA 30519-8783 - Phone
- (470) 201-5717
- NPI assigned
- Nov 22, 2023
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LPC015492 | GA | Primary |
Addresses
Primary practice location
2675 Mall of Georgia Blvd Ste 102
Buford, GA 30519-8783
Mailing address
145 PR Smith Blvd
Winder, GA 30680-8023
Phone (404) 574-0359
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 |
|---|---|---|---|
| LPC015492 | GA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1700611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756944000000",
"number": "1720853377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "145 PR SMITH BLVD",
"city": "WINDER",
"state": "GA",
"postal_code": "306808023",
"telephone_number": "404-574-0359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2675 MALL OF GEORGIA BLVD STE 102",
"city": "BUFORD",
"state": "GA",
"postal_code": "305198783",
"telephone_number": "470-201-5717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUSTOSA",
"first_name": "KAYLA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-11-22",
"last_updated": "2025-09-04",
"certification_date": "2025-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "GA",
"license": "LPC015492",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buford, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.