Individual provider Active NPI

Kimberly Michele Green, LPC, CSAC

  • Professional Counselor
  • Hampton, VA
National Provider Identifier
1790269967
Registry record updated Sep 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
0701007734 Issued in VA
Practice address
2202 Executive Dr Ste C
Hampton, VA 23666-6604
Phone
(757) 827-7707
Fax
(757) 838-2573
NPI assigned
Sep 24, 2018
Last updated
Sep 24, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2018

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 0701007734 VA Primary

Addresses

Primary practice location

2202 Executive Dr Ste C
Hampton, VA 23666-6604

Mailing address

2202 Executive Dr Ste C
Hampton, VA 23666-6604
Phone (757) 827-7707

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
I20240730002787 VA Practitioner - Mental Health Counselor 9335686112 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Thrive Counseling LLCGroup PAC ID 0749458420, 1,187 clinicians

Practice addresses (Care Compare)

1030 Loftis Blvd
Suite 102
Newport News, VA 23606-2999
Phone (855) 284-7483

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0701007734VAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Thrive Counseling LLC CurrentSince Jul 11, 2024 Accepting new patients

Locations

1030 Loftis Blvd
Ste 102
Newport News, VA 23606
Phone (978) 998-5022

5310 Markel Rd
Ste 102
Richmond, VA 23230
Phone (804) 312-5498

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1537747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537747200000",
    "number": "1790269967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2202 EXECUTIVE DR STE C",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236666604",
            "telephone_number": "757-827-7707",
            "fax_number": "757-838-2573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 EXECUTIVE DR STE C",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236666604",
            "telephone_number": "757-827-7707",
            "fax_number": "757-838-2573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "KIMBERLY",
        "middle_name": "MICHELE",
        "credential": "LPC, CSAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-24",
        "last_updated": "2018-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701007734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hampton, VA

Sources for this page

Verify at the official NPI Registry.