Kenyah Monet Mickens-Smith, LMFT, LCAS

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

2490

Practice address

1300 Baxter St Ste 421
Charlotte, NC 28204-3026

Phone

(704) 995-0342

Fax

(704) 943-0707

NPI assigned

Sep 25, 2020

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Mental Health Counselor

Education

Other, 2019

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Achieve Balance, PLLC

  • Marriage & Family Therapist
  • Charlotte, NC
  • NPI 1265934731
  Medicare reassignment NPD

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

{
    "created_epoch": "1600992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1831706704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7745 BALLANTYNE COMMONS PKWY STE 102",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282775056",
            "telephone_number": "704-995-0342",
            "fax_number": "704-943-0707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 BAXTER ST STE 421",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043026",
            "telephone_number": "704-995-0342",
            "fax_number": "704-943-0707"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7745 Ballantyne Commons Pkwy Ste 102",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282775056",
            "country_code": "US",
            "telephone_number": "704-995-0342",
            "fax_number": "704-943-0707",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MICKENS-SMITH",
        "first_name": "KENYAH",
        "middle_name": "MONET",
        "credential": "LMFT, LCAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-25",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": "2490",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LMFT",
            "identifier": "2490",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa M Michaud, OTR/L
• Chenel Michel, M.D.
• Montana Mick, BSW
• Meredith A Mickalis
• Marcus Mickell
• Micum Health PLLC
• Mid Carolina Cardiology 2LLC
• Mid Carolina Psychiatry, PA
• Mid-Atlantic Emergency Medical Associates, PLLC
• Mid-Charlotte Dermatology and Research PLLC

• Marriage & Family Therapist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Marriage & Family Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; 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.