Individual provider Active NPI

Krystal Symeonides, PH.D., LPC, LSATP

  • Professional Counselor
  • North Chesterfield, VA
National Provider Identifier
1366831018
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
0701011153 Issued in VA
Practice address
2529 Professional Rd
North Chesterfield, VA 23235-3235
Phone
(804) 864-2273
Fax
(844) 822-6333
NPI assigned
Jan 19, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 0718000651 VA
Professional Counselor 101YP2500X 0701011153 VA Primary

Addresses

Primary practice location

2529 Professional Rd
North Chesterfield, VA 23235-3235

Mailing address

11059 E Bethany Dr Ste 200
Aurora, CO 80014-2637
Phone (303) 617-2300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
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

Enrollment IDStateProvider typePAC IDDetails
I20240826002108 DC Practitioner - Mental Health Counselor 2668911322 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
0718000651VAMDAddiction (Substance Use Disorder) Counselor
0701011153VAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Mental Health CurrentSince Jul 23, 2024 Accepting new patients
Associated Behavioral Outcomes & Developmental Experts of VA, Inc. Past Accepting new patients

Locations

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

8300 Boone Blvd
Ste 500
Vienna, VA 22182
Phone (703) 884-2598

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1421625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1366831018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11059 E BETHANY DR STE 200",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800142637",
            "telephone_number": "303-617-2300",
            "fax_number": "303-617-2397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2529 PROFESSIONAL RD",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232353235",
            "telephone_number": "804-864-2273",
            "fax_number": "844-822-6333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SYMEONIDES",
        "first_name": "KRYSTAL",
        "credential": "PH.D., LPC, LSATP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-19",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "VA",
            "license": "0718000651",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701011153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Chesterfield, VA

Sources for this page

Verify at the official NPI Registry.