Active NPI
Lateshia Shuvone Woodley, LPC, NCC
- Counselor
- Ellenwood, GA
National Provider Identifier
1922262526
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- LPC 005270
- Practice address
- 2676 Holly Berry Dr
Ellenwood, GA 30294-3997 - Phone
- (404) 399-6161
- Fax
- (404) 363-4062
- NPI assigned
- Jul 12, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | LPC 005270 | GA | Primary |
| School Counselor | 101YS0200X | 748266 | GA |
Addresses
Primary practice location
2676 Holly Berry Dr
Ellenwood, GA 30294-3997
Mailing address
2676 Holly Berry Dr
Ellenwood, GA 30294-3997
Phone (404) 399-6161
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 |
|---|---|---|---|
| LPC 005270 | GA | MD | Counselor |
| 748266 | GA | MD | School Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215820800000",
"number": "1922262526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2676 HOLLY BERRY DR",
"city": "ELLENWOOD",
"state": "GA",
"postal_code": "302943997",
"telephone_number": "404-399-6161",
"fax_number": "404-363-4062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2676 HOLLY BERRY DR",
"city": "ELLENWOOD",
"state": "GA",
"postal_code": "302943997",
"telephone_number": "404-399-6161",
"fax_number": "404-363-4062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOODLEY",
"first_name": "LATESHIA",
"middle_name": "SHUVONE",
"name_prefix": "Dr.",
"credential": "LPC, NCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-12",
"last_updated": "2008-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "GA",
"license": "LPC 005270",
"primary": true
},
{
"code": "101YS0200X",
"taxonomy_group": "",
"desc": "Counselor, School",
"state": "GA",
"license": "748266",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellenwood, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.