Katie Wilson Conklin, LPC
Individual provider Active NPI Professional Counselor · Martinsville, VA
NPI 1679276372 · NPPES record last updated Nov 3, 2023
Key facts
- NPI
- 1679276372
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 0701012267 (VA)
- Practice address
- 24 Clay St
Martinsville, VA 24112-2810 - Phone
- (276) 694-4361
- Fax
- (276) 694-3445
- NPI assigned
- Mar 23, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Piedmont Regional Community Services Board
Practice addresses (Care Compare)
22280 Jeb Stuart Hwy
Stuart, VA 24171-2999
Phone 27663271281339
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240109003547 | VA | Practitioner - Mental Health Counselor | 2365893864 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Piedmont Regional Community Services Board | Current |
Accepting new patients |
Locations
24 Clay St
Martinsville, VA 24112
Phone (276) 632-7128
22280 Jeb Stuart Hwy
Stuart, VA 24171
Phone (276) 632-7128
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0701012267 | VA | Yes |
Addresses
Primary practice location
24 Clay St
Martinsville, VA 24112-2810
Mailing address
24 Clay St
Martinsville, VA 24112-2810
Phone (276) 694-4361
Other providers in Martinsville, VA
- Martha Willis Cole
- May Ann Gaviola Coleman
- Commonwealth Family Physicians, Inc.
- Commonwealth of Virginia State Board of Health
- Compassionate Care Pediatrics, LLC
- Kelsey Sarah Conlon
- Robert Shane Cooper
- Amber Triplett Corns
- Mackenzie Quinn Coulson
- Counseling With Kelli LLC
All providers in Martinsville, VA · Professional Counselor in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.