Khadija Manssouri, LCSW

Primary specialty

CounselorTaxonomy code 101Y00000X

License

0904019070 Issued in VA

Practice address

1801 Braeburn Dr Apt 205
Salem, VA 24153-7341

Phone

(540) 685-7177

NPI assigned

Sep 15, 2025

Last updated

Sep 15, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ascension Psychiatric Services LLCGroup PAC ID 0840723557, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Ascension Psychiatric Services LLC

  • Psychiatry Physician
  • Hopewell, VA
  • NPI 1184471898
  Medicare reassignment Care Compare group
• KL Gash & Associates LLC

  • Clinical Social Worker
  • Hampton, VA
  • NPI 1699384149
  Medicare reassignment NPD

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

{
    "created_epoch": "1757894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757894400000",
    "number": "1336010370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 BRAEBURN DR APT 205",
            "city": "SALEM",
            "state": "VA",
            "postal_code": "241537341",
            "telephone_number": "540-685-7177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 BRAEBURN DR APT 205",
            "city": "SALEM",
            "state": "VA",
            "postal_code": "241537341",
            "telephone_number": "540-685-7177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSSOURI",
        "first_name": "KHADIJA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-09-15",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "VA",
            "license": "0904019070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Owori Bwire Mang'Eni
• Christine Anne Mangone, OTR/L
• Julie W Manico, DPT, MSPT
• Caroline E Mann, PHD
• Gloria Polk Manns, LCSW
• Leonard Jeffrey Marcus, MD
• Kathryn Magruder Marencik, RPH
• Richard M Marencik, RPH
• Jennifer L Mark, M.D.
• Jordyn Mikayla Markle

• Counselor in Salem, VA
• Providers in Salem, VA by specialty
• Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2025; 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.

Verify at the official NPI Registry.