MEDICARE: MICHELE T MIKESELL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904001693	VA
2	1041C0700X	Clinical Social Worker	0904000182	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518039551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHELE T MIKESELL LCSW

Provider Business Mailing Address
First Line	:	2377 PRINCESS ANNE RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-3535
Country	:	US
Telephone Number	:	757-427-5987
Fax Number	:	757-563-0887

Provider Business Practice Location Address
First Line	:	2377 PRINCESS ANNE RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-3535
Country	:	US
Telephone Number	:	757-427-5987
Fax Number	:	757-563-0887

Authorized Official
Title or Position	:	CONSULTANT
Name	:	JULIEANN BEST
Credential	:
Telephone Number	:	757-427-5987

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	05/26/2011

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