Sycamore Wellness Group, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

LPC004217 Issued in GA

Legal business name

SYCAMORE WELLNESS GROUP, LLC

Practice address

5400 Lawrenceville Hwy NW Ste E3
Lilburn, GA 30047-5956

Phone

(404) 503-0701

Fax

(404) 537-1947

NPI assigned

Jun 25, 2018

Last updated

Jun 25, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jamie Gynette Cross Lee, PH.D., LPC, EAS-CNPI 1619933645

Title

Ceo

Phone

(404) 503-0701

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jamie Gynette Cross-Lee, LPC

  • Professional Counselor
  • Lilburn, GA
  • NPI 1619933645
  NPD (past) Authorized official

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

{
    "created_epoch": "1529884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529884800000",
    "number": "1942795836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 LAWRENCEVILLE HWY NW STE E3",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300475956",
            "telephone_number": "404-503-0701",
            "fax_number": "404-537-1947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 LAWRENCEVILLE HWY NW STE E3",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300475956",
            "telephone_number": "404-503-0701",
            "fax_number": "404-537-1947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYCAMORE WELLNESS GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-25",
        "last_updated": "2018-06-25",
        "status": "A",
        "authorized_official_last_name": "CROSS LEE",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_middle_name": "GYNETTE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-503-0701",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D., LPC, EAS-C"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "LPC004217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "501854029A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Lilburn, GA
• Providers in Lilburn, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; 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.