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NPI Code Detail

MEDICARE: MIKEYDA TRAVERS LPC

MEDICARE: MIKEYDA TRAVERS LPC
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
1101YP2500XProfessional Counselor1962143537VA

General Provider Information

NPI Number : 1962143537
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKEYDA TRAVERS LPC
Provider Business Mailing Address
First Line : 207 RANDOLPH ST
Second Line :
City : ASHLAND
State : VA
Zip : 23005-2139
Country : US
Telephone Number : 804-714-5813
Fax Number :
Provider Business Practice Location Address
First Line : 4801 COX RD STE 205
Second Line :
City : GLEN ALLEN
State : VA
Zip : 23060-6803
Country : US
Telephone Number : 804-796-0790
Fax Number : 804-796-0799
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2022
Last Update Date : 02/12/2025

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