Active NPI
Holly S Tickle, M.DIV,LMFT
- Marriage & Family Therapist
- Duluth, GA
National Provider Identifier
1780948521
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFT001179
- Practice address
- 3700 Pleasant Hill Rd
Duluth, GA 30096-3194 - Phone
- (404) 784-6313
- NPI assigned
- Jun 26, 2012
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFT001179 | GA | Primary |
Addresses
Primary practice location
3700 Pleasant Hill Rd
Duluth, GA 30096-3194
Mailing address
4845 Short St
Suwanee, GA 30024-1945
Phone (770) 271-8371
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 |
|---|---|---|---|
| MFT001179 | GA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340668800000",
"number": "1780948521",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4845 SHORT ST",
"city": "SUWANEE",
"state": "GA",
"postal_code": "300241945",
"telephone_number": "770-271-8371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3700 PLEASANT HILL RD",
"city": "DULUTH",
"state": "GA",
"postal_code": "300963194",
"telephone_number": "404-784-6313"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TICKLE",
"first_name": "HOLLY",
"middle_name": "S",
"name_prefix": "Ms.",
"credential": "M.DIV,LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-06-26",
"last_updated": "2012-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "GA",
"license": "MFT001179",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duluth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.