Micah J Park, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

0101281727 Issued in VA

Practice address

19420 Golf Vista PLZ Ste 250
Lansdowne, VA 20176-8267

Phone

(804) 207-6737

Fax

(703) 665-7686

NPI assigned

May 27, 2020

Last updated

Apr 29, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Commonwealth Counseling Associates Inc

  dba LifeStance Health

  • Clinical Psychologist
  • Mechanicsville, VA
  • NPI 1851345805

  Psychiatry

  Medicare reassignment NPD

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

{
    "created_epoch": "1590537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777420800000",
    "number": "1659994473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 N SCOTTSDALE RD STE 2500",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852517630",
            "telephone_number": "804-207-6737",
            "fax_number": "703-665-7686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19420 GOLF VISTA PLZ STE 250",
            "city": "LANSDOWNE",
            "state": "VA",
            "postal_code": "201768267",
            "telephone_number": "804-207-6737",
            "fax_number": "703-665-7686"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Alabama Ave SE",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200324542",
            "country_code": "US",
            "telephone_number": "202-299-5334",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "MICAH",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-27",
        "last_updated": "2026-04-29",
        "certification_date": "2026-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "0101281727",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oncology/Hematology of Loudoun and Reston, P.C.
• Rebecca Measell Owens, PHD, CCC-A
• Sobha Rani Paluvoi, M.D.
• Srinagesh Paluvoi, M.D.
• Lindsey Michelle Paniszczyn, MS, RDN, LDN
• A. Carminda Passino, MSSW
• Vishal Anil Patel, MD
• Kristen Patrick
• Kathleen Waggoner Petty, LCSW, CSAC
• Anh Huu Pham, DDS

• Psychiatry Physician in Lansdowne, VA
• Providers in Lansdowne, VA by specialty
• Psychiatry Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2026; 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.