Individual provider Active NPI

Aleasha Mitchell

  • Mental Health Counselor
  • Archdale, NC
National Provider Identifier
1417520693
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
16604 Issued in NC
Practice address
6465 Allendale Dr
Archdale, NC 27263-3832
Phone
(409) 504-5799
NPI assigned
Jul 23, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X A16604 NC
Mental Health Counselor 101YM0800X 16604 NC Primary

Addresses

Primary practice location

6465 Allendale Dr
Archdale, NC 27263-3832

Mailing address

6465 Allendale Dr
Archdale, NC 27263-3832

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241206000902 NC Practitioner - Mental Health Counselor 7810423464 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
A16604NCMDMental Health Counselor
16604NCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Amazing Space Counseling, PLLC Mental Health CurrentSince Jul 1, 2024 Accepting new patients

Locations

1220 N Main St
High Point, NC 27262
Phone (409) 504-5799

Organizations & group practices 1

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": "1626998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1417520693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6465 ALLENDALE DR",
            "city": "ARCHDALE",
            "state": "NC",
            "postal_code": "272633832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6465 ALLENDALE DR",
            "city": "ARCHDALE",
            "state": "NC",
            "postal_code": "272633832",
            "telephone_number": "409-504-5799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "ALEASHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-23",
        "last_updated": "2024-01-30",
        "certification_date": "2021-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A16604",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "16604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Archdale, NC

Sources for this page

Verify at the official NPI Registry.