Kisha Wynnette Mickens, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0701012722 Issued in VA

Practice address

3210 Mattaponi Ave
West Point, VA 23181-9307

Phone

(804) 767-0973

NPI assigned

Aug 10, 2023

Last updated

Aug 10, 2023By 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

Mental Health Counselor

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Colonial Behavioral HealthGroup PAC ID 7012010549, 18 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/2b8c86f5-c497-45b0-94ed-0102e20d1c70/

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.

• Colonial Behavioral Health

  • Community/Behavioral Health Agency
  • Williamsburg, VA
  • NPI 1760565915
  Medicare reassignment Care Compare group NPD
• Colonial Behavioral Health

  • Health Maintenance Organization
  • Williamsburg, VA
  • NPI 1841556776
  NPD (past)

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

{
    "created_epoch": "1691625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1447933973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3210 MATTAPONI AVE",
            "city": "WEST POINT",
            "state": "VA",
            "postal_code": "231819307",
            "telephone_number": "804-767-0973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3210 MATTAPONI AVE",
            "city": "WEST POINT",
            "state": "VA",
            "postal_code": "231819307",
            "telephone_number": "804-767-0973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKENS",
        "first_name": "KISHA",
        "middle_name": "WYNNETTE",
        "name_prefix": "Ms.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-10",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701012722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leap Speech Therapy
• Jonathan M. Lloyd, PT, DPT
• Lora Ann Lydick, RPH
• Jenna M McCormick, LCSW
• Courtney J McTheny, PT, DPT
• Mark Milton Neale Jr., DDS MAGD FICOI
• Hien Nguyen
• Patrick Henry Hospital, Inc. (Riverside Convalescent Center, West Point)
• Susan Kirby Pence, RPH
• Rachel Teagle

• Professional Counselor in West Point, VA
• Providers in West Point, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; 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.