=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922767169
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN MICHELE FLEETWOOD LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2021
-----------------------------------------------------
Last Update Date | 08/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11159 AIR PARK RD
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23005-3500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-994-7384
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15567 ROBERT TERRELL RD
-----------------------------------------------------
City | MONTPELIER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23192-2221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-994-7384
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0701010600
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 0701010600
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------