Individual
MS. KISHA WYNNETTE MICKENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
3210 MATTAPONI AVE, WEST POINT, VA 23181-9307
(804) 767-0973
Mailing address
3210 MATTAPONI AVE, WEST POINT, VA 23181-9307
(804) 767-0973
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701012722
VA
Other
Enumeration date
08/10/2023
Last updated
08/10/2023
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