Healthcare Provider Details

I. General information

NPI: 1114410016
Provider Name (Legal Business Name): MICHAELA AFTON BARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 2ND ST
RICHLANDS VA
24641-2305
US

IV. Provider business mailing address

2408 SUSANNAH ST STE 1
JOHNSON CITY TN
37601-1765
US

V. Phone/Fax

Practice location:
  • Phone: 276-345-9900
  • Fax: 276-345-9901
Mailing address:
  • Phone: 423-434-6677
  • Fax: 423-461-0000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701011274
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: