Mark Wagemaker, LPC 5042

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC5042 Issued in GA

Practice address

402B Adamson SQ
Suite 11
Carrollton, GA 30117-3214

Phone

(404) 580-6684

NPI assigned

Mar 9, 2007

Last updated

Aug 5, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249430400000",
    "number": "1891826822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1196",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301120022",
            "telephone_number": "404-580-6684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402B ADAMSON SQ",
            "address_2": "SUITE 11",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173214",
            "telephone_number": "404-580-6684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGEMAKER",
        "first_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "LPC 5042",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-09",
        "last_updated": "2009-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC5042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Carrollton, GA
• Providers in Carrollton, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2009; 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.