Mindful Athletes

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

MINDFUL ATHLETES

Practice address

12569 Plymouth CT
Woodbridge, VA 22192-2349

Phone

(703) 220-0037

NPI assigned

Jan 26, 2022

Last updated

Jan 26, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kailyn Rae Slade, LCSWNPI 1730779596

Title

Licensed Clinical Social Worker

Phone

(703) 220-0037

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kailyn R Slade, LCSW

  • School Social Worker
  • Woodbridge, VA
  • NPI 1730779596

  Clinical

  NPD Authorized official

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

{
    "created_epoch": "1643155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643155200000",
    "number": "1467104844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12569 PLYMOUTH CT",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922349",
            "telephone_number": "703-220-0037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12569 PLYMOUTH CT",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922349",
            "telephone_number": "703-220-0037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL ATHLETES",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-26",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A",
        "authorized_official_last_name": "SLADE",
        "authorized_official_first_name": "KAILYN",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "LICENSED CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "703-220-0037",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "2123",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles S Mills III, PT
• Daniel S Mills, PT, DPT
• Theodore Ross Mills, DPT
• Mind Care Professional Limited Liability Company
• Mind Perception Therapy
• Marlene Mireles, PT, DPT
• Lisa M Miroff, DPT
• Mary Mischtschuk, LCSW
• Misk LLC (lifetime pharmacy and compounding)
• Karley Miskimens, MS, CCC- SLP

• Clinical Social Worker in Woodbridge, VA
• Providers in Woodbridge, 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 Jan 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.