Victory Child & Adolescent Counseling

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

VICTORY CHILD & ADOLESCENT COUNSELING

Practice address

1247 Tuscany Dr Ste B1
Braselton, GA 30517-3561

Phone

(678) 465-8665

NPI assigned

Apr 5, 2022

Organization subpart

No

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

Authorized official

Name

Ms. Amberly Ellis, MS, LPC, RPTNPI 1639666704

Title

Professional Counselor

Phone

(678) 465-8665

Specialties & licenses 1

Addresses

Other names 1

• The Victorious Mind Doing business as

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amberly Ellis, LPC

  • Mental Health Counselor
  • Braselton, GA
  • NPI 1639666704
  NPD Authorized official

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649116800000",
    "number": "1922749837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1247 TUSCANY DR STE B1",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "305173561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1247 TUSCANY DR STE B1",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "305173561",
            "telephone_number": "678-465-8665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY CHILD & ADOLESCENT COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-04",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "AMBERLY",
        "authorized_official_title_or_position": "PROFESSIONAL COUNSELOR",
        "authorized_official_telephone_number": "678-465-8665",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS, LPC, RPT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amberly@thevictoriousmind.org",
            "affiliation": "N",
            "address_1": "1247 Tuscany Dr Ste B1",
            "city": "Braselton",
            "state": "GA",
            "country_code": "US",
            "postal_code": "305173561",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "The Victorious Mind",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gursimran Nanki Udhwani, DO
• Muhammad Usman, MD
• Sreeju Vallikattil Gopi, AGACNP
• Nijja Vargas, PA
• Maria Vetrano, PA
• Vineyards Dental Care
• Laura Jean Vogt, AGACNP
• Mariana Voronovscaia, AGACNP
• Jeremy Warren Walker, D.O.
• Lance Walker, DC

• Mental Health Clinic/Center (Including Community Mental Health Center) in Braselton, GA
• Providers in Braselton, GA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; 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.