Individual provider Active NPI

Shantise Nicole Hood, LPC

  • Professional Counselor
  • Woodbridge, VA
National Provider Identifier
1528806239
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
0701013768 Issued in VA
Practice address
4004 Genesee PL Ste 205
Woodbridge, VA 22192-8305
Phone
(571) 275-6052
NPI assigned
Jul 17, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 0701013768 VA Primary

Addresses

Primary practice location

4004 Genesee PL Ste 205
Woodbridge, VA 22192-8305

Mailing address

4004 Genesee PL Ste 205
Woodbridge, VA 22192-8305
Phone (571) 275-6052

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20241025000133 VA Practitioner - Mental Health Counselor 3476086703 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prince William County Community Services BoardGroup PAC ID 7113912973, 57 clinicians

Practice addresses (Care Compare)

7969 Ashton Ave
Manassas, VA 20109-2885
Phone (703) 792-7800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0701013768VAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Prince William County Community Services Board CurrentSince Jul 29, 2024 Accepting new patients
Prince William County CurrentSince Jul 29, 2024 Accepting new patients

Locations

7969 Ashton Ave
Manassas, VA 20109
Phone (703) 792-7826

14011 Worth Ave
Ste 110
Woodbridge, VA 22192

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": "1721174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1528806239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4004 GENESEE PL STE 205",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221928305",
            "telephone_number": "571-275-6052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4004 GENESEE PL STE 205",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221928305",
            "telephone_number": "571-275-6052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOOD",
        "first_name": "SHANTISE",
        "middle_name": "NICOLE",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-17",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701013768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

Verify at the official NPI Registry.