Danielle Lidke-Prow, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPC012120 Issued in GA

Practice address

513 Gloucester St
Brunswick, GA 31520-7014

Phone

(912) 289-2497

NPI assigned

Jun 24, 2022

Last updated

Jun 24, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Specialty

Mental Health Counselor

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gateway Community Service BoardGroup PAC ID 3173510237, 42 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Gateway Community Service Board

  • Community/Behavioral Health Agency
  • Brunswick, GA
  • NPI 1558478214
  Medicare reassignment Care Compare group NPD
• Gateway Behavioral Health Services

  • Mental Illness Community Based Residential Treatment Facility
  • Brunswick, GA
  • NPI 1124254321
  NPD
• Radiant Counseling, LLC

  • Mental Health Counselor
  • Brunswick, GA
  • NPI 1043722705
  NPD
• Gateway Behavioral Health Services

  • Community/Behavioral Health Agency
  • Springfield, GA
  • NPI 1073642211
  NPD (past)

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

{
    "created_epoch": "1656028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656028800000",
    "number": "1780315218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1117 KINGS CROSS",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315256822",
            "telephone_number": "303-515-0125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 GLOUCESTER ST",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315207014",
            "telephone_number": "912-289-2497"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 Coastal Village Dr",
            "address_purpose": "LOCATION",
            "city": "Brunswick",
            "state": "GA",
            "postal_code": "315201974",
            "country_code": "US",
            "telephone_number": "912-554-8500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIDKE-PROW",
        "first_name": "DANIELLE",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-24",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "LPC012120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Brunswick",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "513 Gloucester St",
            "city": "Brunswick",
            "state": "GA",
            "country_code": "US",
            "postal_code": "315207014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Counselor in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.