Alyssa Faith Shadbolt, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904013859 Issued in VA

Practice address

3910 Old Buckingham Rd
Powhatan, VA 23139-5757

Phone

(804) 464-8803

NPI assigned

Mar 29, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Commonwealth Counseling Associates IncGroup PAC ID 0941288583, 207 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Commonwealth Counseling Associates Inc

  • Clinical Psychologist
  • Mechanicsville, VA
  • NPI 1851345805

  Mental Health

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1648512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659484800000",
    "number": "1457091415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3910 OLD BUCKINGHAM RD",
            "city": "POWHATAN",
            "state": "VA",
            "postal_code": "231395757",
            "telephone_number": "804-464-8803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3910 OLD BUCKINGHAM RD",
            "city": "POWHATAN",
            "state": "VA",
            "postal_code": "231395757",
            "telephone_number": "804-464-8803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADBOLT",
        "first_name": "ALYSSA",
        "middle_name": "FAITH",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-29",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904013859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1467448571",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rockwell Physicians of Salisbury
• Julie Marie Roeger, DOULA (DONA)
• James Sanitate
• Scitest Laboratories Inc
• Sophia Eisdorfer Settle, MS, LPC
• Rebecca Shepka, LMT
• Mary Therese Shepperson, RPH
• Mark Shiflett
• Nadirah Shorey, PHARMD
• Shelley Cronin Short, MD

• Clinical Social Worker in Powhatan, VA
• Providers in Powhatan, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2022; 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.