Active NPI
Lavonda K Mickens, PHD
- Clinical Psychologist
- Washington, DC
National Provider Identifier
1316192073
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 25833
- Practice address
- 5801 Army Pentagon Corridor 8, Room 130
Washington, DC 20301-5801 - Phone
- (703) 614-6562
- NPI assigned
- Nov 22, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | |||
| Clinical Psychologist | 103TC0700X | 25833 | CA | Primary |
Addresses
Primary practice location
5801 Army Pentagon Corridor 8, Room 130
Washington, DC 20301-5801
Mailing address
5801 Army Pentagon Corridor 8, Room 130
Washington, DC 20301-5801
Phone (703) 614-6562
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25833 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1227312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692144000000",
"number": "1316192073",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5801 ARMY PENTAGON CORRIDOR 8, ROOM 130",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "203015801",
"telephone_number": "703-614-6562"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5801 ARMY PENTAGON CORRIDOR 8, ROOM 130",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "203015801",
"telephone_number": "703-614-6562"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICKENS",
"first_name": "LAVONDA",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-22",
"last_updated": "2023-08-16",
"certification_date": "2023-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "25833",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.