Active NPI
Lisa Nicole Sells, LPC
- Professional Counselor
- Manassas, VA
National Provider Identifier
1164752135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 0701004746
- Practice address
- 7969 Ashton Ave
Manassas, VA 20109-2885 - Phone
- (703) 792-7800
- Fax
- (703) 792-5699
- NPI assigned
- Jan 13, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0701004746 | VA | Primary |
Addresses
Primary practice location
7969 Ashton Ave
Manassas, VA 20109-2885
Mailing address
7969 Ashton Ave
Manassas, VA 20109-2885
Phone (703) 792-7800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004945247 | Medicaid | VA |
Other names 1
- Lisa Nicole Petersen
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 30, 2024 through Jan 30, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0701004746 | VA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1263340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263340800000",
"number": "1164752135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7969 ASHTON AVE",
"city": "MANASSAS",
"state": "VA",
"postal_code": "201092885",
"telephone_number": "703-792-7800",
"fax_number": "703-792-5699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7969 ASHTON AVE",
"city": "MANASSAS",
"state": "VA",
"postal_code": "201092885",
"telephone_number": "703-792-7800",
"fax_number": "703-792-5699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SELLS",
"first_name": "LISA",
"middle_name": "NICOLE",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-01-13",
"last_updated": "2010-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "VA",
"license": "0701004746",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004945247",
"state": "VA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LISA",
"last_name": "PETERSEN",
"middle_name": "NICOLE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Manassas, VA
- Samuel Woldeghebriel Seium, LPC
- Selah Therapy Services LLC
- Select Physical Therapy Holdings, Inc. (Select Physical Therapy)
- Sellati & Co., Inc. (Manassas Comprehensive Treatment Center)
- Sellati & Co., Inc. (Manassas Comprehensive Treatment Center)
- Kathy Selz
- Mehrez Sendi, BCBA
- Seren Medical Supplies & Equipment LLC
- Servant Pharmacy of Virginia Inc (Servant Pharmacy of Virginia)
- Service Excellence Home Health Care LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.