Provider Demographics
NPI:1962143537
Name:TRAVERS, MIKEYDA (LPC)
Entity type:Individual
Prefix:
First Name:MIKEYDA
Middle Name:
Last Name:TRAVERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-2139
Mailing Address - Country:US
Mailing Address - Phone:804-714-5813
Mailing Address - Fax:
Practice Address - Street 1:4801 COX RD STE 205
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6803
Practice Address - Country:US
Practice Address - Phone:804-796-0790
Practice Address - Fax:804-796-0799
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1962143537101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional