1. Home
  2. Directory
  3. Virginia
  4. Williamsburg
  5. Social Worker
  6. NPI Profile

AUTHENTIC SELF ASSOCIATION LLC
NPI 1720854466
Social Worker - Clinical in Williamsburg, VA

Active since December 04, 2023
4404 EAGLEBROOK DR, WILLIAMSBURG, VA 23188(757) 918-3381 Get Directions Write a Review

NPPES record last updated: December 4, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Authentic Self Association Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AUTHENTIC SELF ASSOCIATION LLC (NPI 1720854466) is a healthcare organization registered as a clinical in Williamsburg, Virginia and active in the NPI registry since December 2023. The organization lists Coty A Mills, Owner/therapist, as its authorized official.

NPPES Registry Identity

NPI1720854466
Entity TypeOrganization
Primary Taxonomy1041C0700X
Legal Business NameAUTHENTIC SELF ASSOCIATION LLC
Location Address4404 EAGLEBROOK DRWilliamsburg, VA 23188-8038
Mailing Address4404 Eaglebrook DrWilliamsburg, VA 23188-8038 · (757) 918-3381
Phone(757) 918-3381
Organization SubpartNo
Authorized OfficialCoty A MillsOwner/therapist · (757) 918-3381
Enumeration DateDecember 4, 2023
NPPES CertifiedDecember 2, 2023
✔ NPI 1720854466 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
4404 EAGLEBROOK DR, Williamsburg, VA 23188
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Authentic Self Association Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Authentic Self Association LLC, which bills Medicare for the services they deliver. Of these, 3 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (3)

Laura Mangelsdorf, LCSW
Clinical Social Worker
NPI 1437036944
1158 PROFESSIONAL DR STE G
Williamsburg, VA 23185
(757) 713-6017
✔ PECOS✔ Accepts Medicare2.1 mi
Kerrie Shively
Mental Health Counselor
NPI 1134051634
1158 PROFESSIONAL DR STE G
Williamsburg, VA 23185
(757) 349-6463
✔ PECOS2.1 mi
Coty Mills, LCSW
Clinical Social Worker
NPI 1952928095
1303 MOUNT VERNON AVE
Williamsburg, VA 23185
(757) 918-3381
✔ PECOS✔ Accepts Medicare2.5 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Authentic Self Association LLC's NPI number?

The NPI number for Authentic Self Association LLC is 1720854466. It was assigned to this organization in the NPPES registry on December 4, 2023.

Where is Authentic Self Association LLC located?

Authentic Self Association LLC is located at 4404 Eaglebrook Dr, Williamsburg, VA 23188. The listed phone number is (757) 918-3381.

What is Authentic Self Association LLC's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Authentic Self Association LLC enrolled in Medicare?

Yes. Authentic Self Association LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Authentic Self Association LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Authentic Self Association LLC, in Clinical Social Worker and Mental Health Counselor. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 3 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Authentic Self Association LLC was last updated on December 4, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.