Active NPI
Keva Ellis, LPC
- Professional Counselor
- Riverdale, GA
National Provider Identifier
1801414578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC010433
- Practice address
- 6815 W Fayetteville Rd
Riverdale, GA 30296-2528 - Phone
- (281) 236-6762
- NPI assigned
- Jul 9, 2020
- Last updated
- Jun 27, 2022
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC010433 | GA | Primary |
Addresses
Primary practice location
6815 W Fayetteville Rd
Riverdale, GA 30296-2528
Mailing address
6815 W Fayetteville Rd
Riverdale, GA 30296-2528
Phone (907) 984-2477
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 |
|---|---|---|---|
| LPC010433 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656288000000",
"number": "1801414578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6815 W FAYETTEVILLE RD",
"city": "RIVERDALE",
"state": "GA",
"postal_code": "302962528",
"telephone_number": "907-984-2477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6815 W FAYETTEVILLE RD",
"city": "RIVERDALE",
"state": "GA",
"postal_code": "302962528",
"telephone_number": "281-236-6762"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "KEVA",
"name_prefix": "Ms.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-09",
"last_updated": "2022-06-27",
"certification_date": "2022-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC010433",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverdale, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.