Provider Demographics
NPI:1518039551
Name:MICHELE T MIKESELL LCSW
Entity Type:Organization
Organization Name:MICHELE T MIKESELL LCSW
Other - Org Name:PRINCESS ANNE PSYCHOLOGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:JULIEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-427-5987
Mailing Address - Street 1:2377 PRINCESS ANNE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3535
Mailing Address - Country:US
Mailing Address - Phone:757-427-5987
Mailing Address - Fax:757-563-0887
Practice Address - Street 1:2377 PRINCESS ANNE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-3535
Practice Address - Country:US
Practice Address - Phone:757-427-5987
Practice Address - Fax:757-563-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040016931041C0700X
VA09040001821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008930511Medicaid
VA008928771Medicaid
VA00V800P52Medicare UPIN
VA008930511Medicaid
VA00V801P52Medicare UPIN