Shannon Nakeayva Mines, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0701008071. Issued in VA

Practice address

23331 Dabney Mill Rd
North Dinwiddie, VA 23803-9101

Phone

(804) 837-0630

Fax

(804) 469-4944

NPI assigned

Jan 23, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shannon.mines.p1@direct.d19csb.nextgenshare.com

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.

• District 19 Community Services Board

  • Community/Behavioral Health Agency
  • Petersburg, VA
  • NPI 1225094451
  Medicare reassignment NPD

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

{
    "created_epoch": "1548201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548201600000",
    "number": "1962966010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23331 DABNEY MILL RD",
            "city": "NORTH DINWIDDIE",
            "state": "VA",
            "postal_code": "238039101",
            "telephone_number": "804-837-0630",
            "fax_number": "804-469-4944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23331 DABNEY MILL RD",
            "city": "NORTH DINWIDDIE",
            "state": "VA",
            "postal_code": "238039101",
            "telephone_number": "804-837-0630",
            "fax_number": "804-469-4944"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 W Bank St",
            "address_purpose": "LOCATION",
            "city": "Petersburg",
            "state": "VA",
            "postal_code": "238033279",
            "country_code": "US",
            "telephone_number": "804-481-0146",
            "fax_number": "804-722-4291",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MINES",
        "first_name": "SHANNON",
        "middle_name": "NAKEAYVA",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-23",
        "last_updated": "2019-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701008071.",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in North Dinwiddie, VA
• Providers in North Dinwiddie, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.