MEDICARE: KARISSA KNIGHT

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	101YM0800X	Mental Health Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1962856187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARISSA KNIGHT

Provider Business Mailing Address
First Line	:	909 TURNER RD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-6926
Country	:	US
Telephone Number	:	804-298-8985
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 TURNER RD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-6926
Country	:	US
Telephone Number	:	804-298-8985
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2016
Last Update Date	:	07/18/2023

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