Active NPI
Angela C. Breazeale, LPC
- Professional Counselor
- Johns Creek, GA
National Provider Identifier
1821821786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 003422
- Practice address
- 10475 Medlock Bridge Rd Ste 205
Johns Creek, GA 30097-4446 - Phone
- (678) 474-4899
- NPI assigned
- Aug 24, 2024
- Sex
- Female
- Sole proprietor
- No
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 | 003422 | GA | Primary |
Addresses
Primary practice location
10475 Medlock Bridge Rd Ste 205
Johns Creek, GA 30097-4446
Mailing address
10475 Medlock Bridge Rd Ste 205
Johns Creek, GA 30097-4446
Phone (678) 474-4899
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Aug 26, 2024 through Aug 26, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003422 | GA | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724457600000",
"number": "1821821786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10475 MEDLOCK BRIDGE RD STE 205",
"city": "JOHNS CREEK",
"state": "GA",
"postal_code": "300974446",
"telephone_number": "678-474-4899"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10475 MEDLOCK BRIDGE RD STE 205",
"city": "JOHNS CREEK",
"state": "GA",
"postal_code": "300974446",
"telephone_number": "678-474-4899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREAZEALE",
"first_name": "ANGELA",
"middle_name": "C.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-24",
"last_updated": "2024-08-24",
"certification_date": "2024-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "003422",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Johns Creek, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.