Active NPI
Kelli Danielle Willard, LMFT
- Counselor
- Suwanee, GA
National Provider Identifier
1891455135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- MFT001359
- Practice address
- 912 Little Darby LN
Suwanee, GA 30024-7676 - Phone
- (678) 647-9756
- NPI assigned
- Dec 28, 2021
- Last updated
- Dec 28, 2021
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | MFT001359 | GA | Primary |
Addresses
Primary practice location
912 Little Darby LN
Suwanee, GA 30024-7676
Mailing address
1000 Peachtree Industrial Blvd
Ste 6 Box 222
Suwanee, GA 30024
Phone (678) 647-9756
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 |
|---|---|---|---|
| MFT001359 | GA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1640649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640649600000",
"number": "1891455135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 PEACHTREE INDUSTRIAL BLVD",
"address_2": "STE 6 BOX 222",
"city": "SUWANEE",
"state": "GA",
"postal_code": "30024",
"telephone_number": "678-647-9756"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "912 LITTLE DARBY LN",
"city": "SUWANEE",
"state": "GA",
"postal_code": "300247676",
"telephone_number": "678-647-9756"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLARD",
"first_name": "KELLI",
"middle_name": "DANIELLE",
"name_prefix": "Mrs.",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-12-28",
"last_updated": "2021-12-28",
"certification_date": "2021-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "GA",
"license": "MFT001359",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Suwanee, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.