Active NPI
Ebony Mallard, LPC
- Professional Counselor
- Brookhaven, GA
National Provider Identifier
1942560412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC006830
- Practice address
- 2801 Buford Hwy NE Ste 501
Brookhaven, GA 30329-2137 - Phone
- (404) 491-0377
- NPI assigned
- May 18, 2012
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC006830 | GA | Primary |
Addresses
Primary practice location
2801 Buford Hwy NE Ste 501
Brookhaven, GA 30329-2137
Mailing address
2609 Waterdale Rd SW
Atlanta, GA 30331-8125
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC006830 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1741651200000",
"number": "1942560412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2609 WATERDALE RD SW",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303318125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2801 BUFORD HWY NE STE 501",
"city": "BROOKHAVEN",
"state": "GA",
"postal_code": "303292137",
"telephone_number": "404-491-0377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLARD",
"first_name": "EBONY",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-05-18",
"last_updated": "2025-03-11",
"certification_date": "2025-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC006830",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brookhaven, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.