Nicolas Allen Whited, LPC, CRC, CSAC, PBSF
Individual provider Active NPI Professional Counselor · Pounding Mill, VA
NPI 1881980100 · NPPES record last updated Nov 12, 2015
Key facts
- NPI
- 1881980100
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 0701005169 (VA)
- Practice address
- 113 Short St
Suite 2
Pounding Mill, VA 24637-4278 - Phone
- (276) 963-1028
- NPI assigned
- Jun 24, 2011
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
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 |
|---|---|---|---|---|
| I20241106001595 | VA | Practitioner - Mental Health Counselor | 5597299081 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0710102224 | VA | MD | Addiction (Substance Use Disorder) Counselor |
| 0701005169 | VA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chesterfield Family Guidance Center | Professional | Current |
Accepting new patients |
| Mental Health Specialty Group PA | Professional | Current |
Accepting new patients |
| Marvin Behavioral Health Ma PC | Past | Accepting new patients |
Locations
6603 Irongate Sq
North Chesterfield, VA 23234
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 0710102224 | VA | |
| Professional Counselor | 101YP2500X | 0701005169 | VA | Yes |
Addresses
Primary practice location
113 Short St
Suite 2
Pounding Mill, VA 24637-4278
Mailing address
113 Short St
Suite 2
Pounding Mill, VA 24637-4278
Phone (276) 963-1028
Other providers in Pounding Mill, VA
- Town Center Urgent Care LLC
- Valerie J. Christian, O.D., P.C.
- Wal-Mart Stores East LP
- Wal-Mart Stores East, LP
- Derek Wayne White
- Beverly Christine Young
All providers in Pounding Mill, 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 12, 2015. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.