Kemesha Nickelson, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC014486 Issued in GA

Practice address

11138 States Bridge Rd
Suite 100a
Johns Creek, GA 30022

Phone

(678) 274-4936

NPI assigned

Jan 3, 2022

Last updated

Feb 20, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Pyramid Family Behavioral Healthcare LLC

  dba Pyramid Healthcare Assessment Center

  • Community/Behavioral Health Agency
  • Johns Creek, GA
  • NPI 1306326590
  NPD
• Pyramid Family Behavioral Healthcare LLC

  • Community/Behavioral Health Agency
  • Johns Creek, GA
  • NPI 1609356914
  NPD

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

{
    "created_epoch": "1641168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1801557830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6304 TREE SUMMIT PKWY",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300968080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11138 STATES BRIDGE RD",
            "address_2": "SUITE 100A",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "30022",
            "telephone_number": "678-274-4936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKELSON",
        "first_name": "KEMESHA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-03",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "APC008168",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC014486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• North Atlanta Mental Health LLC (Ellie Mental Health)
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• Professional Counselor in Johns Creek, GA
• Providers in Johns Creek, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.