Active NPI
Danielle McCord Mickelonis, LCMHC, LCAS
- Professional Counselor
- Wilmington, NC
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- A15675
- Practice address
- 615 Shipyard Blvd
Wilmington, NC 28412-6431 - Phone
- (910) 343-0145
- Fax
- (910) 341-5779
- NPI assigned
- Mar 26, 2020
- Last updated
- Aug 30, 2022
- 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 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LCAS-26121 | NC | |
| Mental Health Counselor | 101YM0800X | A15675 | NC | |
| Mental Health Counselor | 101YM0800X | 15675 | NC | |
| Professional Counselor | 101YP2500X | 15675 | NC | |
| Professional Counselor | 101YP2500X | A15675 | NC | Primary |
Addresses
Primary practice location
615 Shipyard Blvd
Wilmington, NC 28412-6431
Mailing address
615 Shipyard Blvd
Wilmington, NC 28412-6431
Phone (910) 343-0145
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
615 Shipyard Blvd
Wilmington, NC 28412-6431
Phone (910) 343-0145
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCAS-26121 | NC | MD | Addiction (Substance Use Disorder) Counselor |
| A15675 | NC | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coastal Horizons Center, Inc | Mental Health | Current | Accepting new patients |
| Coastal Horizons Center Inc | Current | Accepting new patients | |
| Coastal Horizons Center, Inc. | Current | Accepting new patients | |
| Coastal Horizons Center, Inc. | Current | Accepting new patients |
Locations
120 Coastal Horizons Dr
Shallotte, NC 28470
Phone (910) 754-4515
615 Shipyard Blvd
Wilmington, NC 28412
Phone (910) 202-5709
Organizations & group practices 4
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.
-
- Community/Behavioral Health Agency
- Wilmington, NC
- NPI 1922022607
-
- Community/Behavioral Health Agency
- Rocky Point, NC
- NPI 1063082592
-
- Community/Behavioral Health Agency
- Wilmington, NC
- NPI 1033420153
Mental Health
-
- Community/Behavioral Health Agency
- Wilmington, NC
- NPI 1790985448
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661817600000",
"number": "1265069363",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 SHIPYARD BLVD",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284126431",
"telephone_number": "910-343-0145",
"fax_number": "910-341-5779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 SHIPYARD BLVD",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284126431",
"telephone_number": "910-343-0145",
"fax_number": "910-341-5779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICKELONIS",
"first_name": "DANIELLE",
"middle_name": "MCCORD",
"credential": "LCMHC, LCAS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-26",
"last_updated": "2022-08-30",
"certification_date": "2022-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "LCAS-26121",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "A15675",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "15675",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "15675",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "A15675",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Wilmington, NC
- Jaimee Ann Miles Michael, DDS
- Peter John Michaelson, D.O.
- Michele Simpson DDS PLLC (Masonboro Kids Dentistry)
- Alexis G Michonski, MSW, LCSWA
- Susan Miciolek, PHARMACIST
- Melissa Middlebrook, LCSWA
- Vanness Middleton
- Regina Gail Midgett, LPC
- Midnight Bloom Mental Health and Wellness PLLC
- Midtown Speech & Language PLLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.