Kimberly Spellman, PHD, LPC, NCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC014156 Issued in GA

Practice address

1000 Johnson Ferry Rd Ste E150
Marietta, GA 30068-2176

Phone

(470) 382-0583

NPI assigned

Apr 20, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Resilient Minds of Georgia

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Atlanta, GA
  • NPI 1760289250
  NPD Authorized official
• Elgindale Partners, LLC

  dba Ellie Mental Health

  • Mental Health Counselor
  • Marietta, GA
  • NPI 1053036277
  NPD

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

{
    "created_epoch": "1650412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711670400000",
    "number": "1952045528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FERRY RD STE E150",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300682176",
            "telephone_number": "470-382-0583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FERRY RD STE E150",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300682176",
            "telephone_number": "470-382-0583"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2751 Buford Hwy NE Ste 700",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303245510",
            "country_code": "US",
            "telephone_number": "404-948-6975",
            "fax_number": "404-795-0602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPELLMAN",
        "first_name": "KIMBERLY",
        "name_prefix": "Dr.",
        "credential": "PHD, LPC, NCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-20",
        "last_updated": "2024-03-29",
        "certification_date": "2024-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC014156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER LICENSE",
            "identifier": "054012019",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ingrid Speed
• Samantha Nicole Speed
• Ethan Jesse Speir, MD
• Spelios and Associates Delk Road PC
• Spelios and Associates- Summitt PC
• Kareema Spells
• Cornelia C Spencer, CCC-SLP
• Kimberly A Spencer, MD
• Lauren A Spencer
• La'Myia Spentz, CERT HAIRLOSS SPEC

• Professional Counselor in Marietta, GA
• Providers in Marietta, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.