Active NPI
Amani Amanda Mungo, LPC
- Professional Counselor
- Atlanta, GA
National Provider Identifier
1932374584
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC004810
- Practice address
- 1830 Water PL SE Ste 215
Atlanta, GA 30339-7407 - Phone
- (470) 326-6469
- Fax
- (678) 853-2466
- NPI assigned
- Apr 24, 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 004810 | GA | |
| Professional Counselor | 101YP2500X | LPC004810 | GA | Primary |
Addresses
Primary practice location
1830 Water PL SE Ste 215
Atlanta, GA 30339-7407
Mailing address
1830 Water PL SE Ste 215
Atlanta, GA 30339-7407
Phone (470) 326-6469
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004810 | Other | GA | GEORGIA LICENSURE BOARD |
| LPC004810 | Medicaid | GA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Douglasville | Direct |
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 |
|---|---|---|---|
| LPC004810 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643846400000",
"number": "1932374584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1830 WATER PL SE STE 215",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303397407",
"telephone_number": "470-326-6469",
"fax_number": "678-853-2466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1830 WATER PL SE STE 215",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303397407",
"telephone_number": "470-326-6469",
"fax_number": "678-853-2466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUNGO",
"first_name": "AMANI",
"middle_name": "AMANDA",
"name_prefix": "Dr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-24",
"last_updated": "2022-02-03",
"certification_date": "2022-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": "GA",
"license": "004810",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC004810",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEORGIA LICENSURE BOARD",
"identifier": "004810",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "LPC004810",
"state": "GA"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Douglasville",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Douglasville",
"address_1": "1830 Water Pl SE Ste 215",
"city": "Atlanta",
"state": "GA",
"country_code": "US",
"postal_code": "303397407",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 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.