Individual
MIA MICKENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
106 SOUTHPARK DR STE C, BLACKSBURG, VA 24060-6809
(540) 376-3348
Mailing address
1145 SPRUCE ST, CHRISTIANSBURG, VA 24073-3742
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0701008012
VA
101YP2500X
Professional Counselor
Primary
0701008012
VA
Other
Enumeration date
12/07/2018
Last updated
06/12/2023
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