Active NPI
Pamela Jane Madsen, MS
- Mental Health Counselor
- Suwanee, GA
National Provider Identifier
1760027932
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 4411 Suwanee Dam Rd Ste 450
Suwanee, GA 30024-8706 - Phone
- (770) 609-3014
- NPI assigned
- Nov 12, 2019
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Professional Counselor | 101YP2500X | |||
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
4411 Suwanee Dam Rd Ste 450
Suwanee, GA 30024-8706
Mailing address
3681 Devenwood Way
Buford, GA 30519-7872
Phone (913) 235-2345
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14562810 | Other | GA | CAQH |
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
- Credentials
- Master of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sea Change Psychotherapy, LLC | Addiction (Substance Use Disorder) | Current | Accepting new patients |
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.
-
- Professional Counselor
- Atlanta, GA
- NPI 1164111803
Addiction (Substance Use Disorder)
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1573516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1573516800000",
"number": "1760027932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3681 DEVENWOOD WAY",
"city": "BUFORD",
"state": "GA",
"postal_code": "305197872",
"telephone_number": "913-235-2345"
},
{
"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": "770-609-3014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADSEN",
"first_name": "PAMELA",
"middle_name": "JANE",
"credential": "MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-11-12",
"last_updated": "2019-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "14562810",
"state": "GA"
}
],
"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 Nov 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.