Melanie Bariso Agustin, LPC
Individual provider Active NPI Professional Counselor · Norfolk, VA
NPI 1194581322 · NPPES record last updated Feb 26, 2024
Key facts
- NPI
- 1194581322
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 0701013286 (VA)
- Practice address
- 401 Gresham Dr
Norfolk, VA 23507 - Phone
- (757) 668-4673
- NPI assigned
- Feb 26, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250115000984 | VA | Practitioner - Mental Health Counselor | 2961930177 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairfield Psychological Assoc. | Current |
Accepting new patients |
Locations
5265 Providence Rd
Ste 500
Virginia Beach, VA 23464
Phone (757) 354-5379
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0701013286 | VA | Yes |
Addresses
Primary practice location
401 Gresham Dr
Norfolk, VA 23507
Mailing address
850 Southampton Ave
Norfolk, VA 23510-1021
Phone (757) 668-5470
Other providers in Norfolk, VA
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- Satyanisth Tandon Agrawal
- Jennifer Aguado
- Cassyanne L Aguiar Lapsia
- Valery Aguinaldo
- Theodora T Agyei
- Ahhc Inc.
- Ameera Y Ahmad
- Arslan Ahmad
- Neeki Ahmadi
All providers in Norfolk, VA · Professional Counselor in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.