Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 101Y00000X | Counselor | | LPC008251 | GEORGIA | No |
| 2 | 101YM0800X | Counselor | Mental Health | LPC008251 | GEORGIA | No |
| 3 | 101YS0200X | Counselor | School | 641060 | GEORGIA | No |
| 4 | 101YP2500X | Counselor | Professional | 008251 | GEORGIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 79770372 | OTHER | GEORGIA | DUN & BRADSTREET (DUNS ID#) |
| 2 | A922342 | OTHER | GEORGIA | AMERICAN HEALTHCARE ACADEMY (CPR AND AED CERTIFICATION) |
| 3 | 003157272A | MEDICAID | GEORGIA | |
| 4 | 13509476 | OTHER | GEORGIA | CAQH PROVIEW PROVIDER REGISTRY (CAQH PROVIDER #) |
| 5 | NCC668043 | OTHER | | NATIONAL BOARD OF CERTIFIED COUNSELORS (NCC CERTIFICATION) |
| 6 | 1835 | OTHER | GEORGIA | HIGH IMPACT TRAINING AND COUNSELING, INC. (CAMS-II CERTIFICATION) |
| 7 | 6426956 | OTHER | GEORGIA | AMERICAN COUNSELING ASSOCIATION (ACA) |
| 8 | 2079 | OTHER | GEORGIA | LPCAGA (CERTIFIED PROFESSIONAL COUNSELOR SUPERVISOR - CPCS) |
| 9 | 30967662 | OTHER | GEORGIA | THE LICENSED PROFESSIONAL COUNSELORS ASSOCIATION OF GEORGIA (LPCAGA) |
| 10 | 641060 | OTHER | GEORGIA | GEORGIA PROFESSIONAL STANDARDS COMMISSION (CERT. EDUCATOR IN SCHOOL COUNSELING) |
| 11 | LPC008251 | OTHER | GEORGIA | GEORGIA COMPOSITE BOARD OF PROFESSIONAL COUNSELORS, SWS, MFTS (LPC LICENSE) |
| 12 | 020720170 | OTHER | GEORGIA | THE JOHN PRAED FOUNDATION (ANSA CERTIFICATION) |
