Individual provider Active NPI

Nichole Grimes, MA, LPC, LMHC

  • Counselor
  • Roswell, GA
National Provider Identifier
1962991513
Registry record updated Sep 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
LPC012800 Issued in GA
Practice address
1007 Mansell Rd Ste A205
Roswell, GA 30076-5019
Phone
(678) 756-2232
NPI assigned
May 8, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 30, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LPC012800 GA
Counselor 101Y00000X MH13235 FL
Counselor 101Y00000X 3676 AL
Counselor 101Y00000X LPC012800 GA Primary

Addresses

Primary practice location

1007 Mansell Rd Ste A205
Roswell, GA 30076-5019

Mailing address

1007 Mansell Rd Ste A205
Roswell, GA 30076-5019
Phone (678) 756-2232

Other practice location 1

300 Office Park Dr Ste 220
Mountain Brk, AL 35223-2473
Phone (205) 538-3099

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Sep 27, 2025 through Sep 27, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
3676ALMDCounselor
MH13235FLMDCounselor
LPC012800GAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Inner Atlas Counseling, LLC Counselor Current Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1525737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664496000000",
    "number": "1962991513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 MANSELL RD STE A205",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765019",
            "telephone_number": "678-756-2232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 MANSELL RD STE A205",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765019",
            "telephone_number": "678-756-2232"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Office Park Dr Ste 220",
            "address_purpose": "LOCATION",
            "city": "Mountain Brk",
            "state": "AL",
            "postal_code": "352232473",
            "country_code": "US",
            "telephone_number": "205-538-3099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRIMES",
        "first_name": "NICHOLE",
        "credential": "MA, LPC, LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-08",
        "last_updated": "2022-09-30",
        "certification_date": "2022-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC012800",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "FL",
            "license": "MH13235",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AL",
            "license": "3676",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "GA",
            "license": "LPC012800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

Verify at the official NPI Registry.