Michael Stephens Rose Jr., LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0701011721 Issued in VA

Practice address

6184 James D Hagood Hwy
Scottsburg, VA 24589-2681

Phone

(804) 840-7499

NPI assigned

Sep 12, 2022

Last updated

Sep 12, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southside Behavioral Health

  • Community/Behavioral Health Agency
  • Clarksville, VA
  • NPI 1700890761

  Single Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1662940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1033831680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6184 JAMES D HAGOOD HWY",
            "city": "SCOTTSBURG",
            "state": "VA",
            "postal_code": "245892681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6184 JAMES D HAGOOD HWY",
            "city": "SCOTTSBURG",
            "state": "VA",
            "postal_code": "245892681",
            "telephone_number": "804-840-7499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "MICHAEL",
        "middle_name": "STEPHENS",
        "name_suffix": "Jr.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-12",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701011721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shari Chism Medley, NP
• Pathways Youth Services (Peaceful Pathways)
• Pathways Youth Services, LLC
• Pathways Youth Services, LLC
• Mark Romack, OTR
• Jennifer Williamson, OTR/L
• Wrapping Arms Youth Services LLC

• Professional Counselor in Scottsburg, VA
• Providers in Scottsburg, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; 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.