That Counseling Place, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

THAT COUNSELING PLACE, LLC

Practice address

930 Cambria St NE Ste 100
Christiansburg, VA 24073-1631

Phone

(540) 944-4994

Fax

(540) 944-6446

NPI assigned

Jul 21, 2021

Organization subpart

No

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

Authorized official

Name

Selina Harrison Kelly, LCSWNPI 1023505047

Title

Therapist

Phone

(540) 944-4994

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Selina Harrison Kelly, LCSW

  • Clinical Social Worker
  • Christiansburg, VA
  • NPI 1023505047
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1626825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626825600000",
    "number": "1083287676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6605",
            "city": "CHRISTIANSBURG",
            "state": "VA",
            "postal_code": "240686605",
            "telephone_number": "540-944-4994",
            "fax_number": "540-944-6446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 CAMBRIA ST NE STE 100",
            "city": "CHRISTIANSBURG",
            "state": "VA",
            "postal_code": "240731631",
            "telephone_number": "540-944-4994",
            "fax_number": "540-944-6446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THAT COUNSELING PLACE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-21",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "SELINA",
        "authorized_official_middle_name": "HARRISON",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "540-944-4994",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023505047",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1023505047",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "selina@thatcounselingplace.com",
            "affiliation": "N",
            "address_1": "930 Cambria St NE Ste 100",
            "city": "Christiansburg",
            "state": "VA",
            "country_code": "US",
            "postal_code": "240731631",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinical Social Worker in Christiansburg, VA
• Providers in Christiansburg, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.