NPIMap

Organization Active NPI

Canton Counseling, LLC

  • Professional Counselor
  • Canton, GA
National Provider Identifier
1780014720
Registry record updated Nov 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC005635 Issued in GA
Legal business name
CANTON COUNSELING, LLC
Practice address
310 Paper Trail Way
Suite 106
Canton, GA 30115-5203
Phone
(678) 880-4645
Fax
(770) 628-0046
NPI assigned
Nov 12, 2013
Last updated
Nov 12, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2013

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

Authorized official

Name
Kristen Fraser, LPCNPI 1922389279
Title
Owner
Phone
(678) 880-4645

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X LPC005635 GA Primary

Addresses

Primary practice location

310 Paper Trail Way
Suite 106
Canton, GA 30115-5203

Mailing address

310 Paper Trail Way
Suite 106
Canton, GA 30115-5203
Phone (678) 880-4645

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240906000206 GA Part B Supplier - Clinic/Group Practice 9830639749 Receives reassigned benefits from 10 practitioners
Practice locations: Canton, GA

National Provider Directory

National Provider Directory

Locations

310 Paper Trail Way
Ste 106
Holly Springs, GA 30115
Phone (678) 880-4645

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1384214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384214400000",
    "number": "1780014720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 PAPER TRAIL WAY",
            "address_2": "SUITE 106",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301155203",
            "telephone_number": "678-880-4645",
            "fax_number": "770-628-0046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 PAPER TRAIL WAY",
            "address_2": "SUITE 106",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301155203",
            "telephone_number": "678-880-4645",
            "fax_number": "770-628-0046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANTON COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-12",
        "last_updated": "2013-11-12",
        "status": "A",
        "authorized_official_last_name": "FRASER",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-880-4645",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC005635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.