Keisa Ayana Brooks-bacote, | |
431 Edgar Cir, Thomson, GA 30824-1600 | |
(864) 554-1453 | |
Not Available |
Full Name | Keisa Ayana Brooks-bacote |
---|---|
Gender | Female |
Speciality | Counselor - Professional |
Location | 431 Edgar Cir, Thomson, Georgia |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1932235322 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
101YP2500X | Counselor - Professional | LPC008161 (Georgia) | Primary |
Entity Name | Grow Healthcare Group Pa |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1245845932 PECOS PAC ID: 3476961368 Enrollment ID: O20220315000829 |
Mailing Address | Practice Location Address |
---|---|
Keisa Ayana Brooks-bacote, 431 Edgar Cir, Thomson, GA 30824-1600 Ph: (864) 554-1453 | Keisa Ayana Brooks-bacote, 431 Edgar Cir, Thomson, GA 30824-1600 Ph: (864) 554-1453 |
Chantell Scott, Counselor Medicare: Not Enrolled in Medicare Practice Location: 322 Hospital Dr, Thomson, GA 30824 Phone: 709-595-2548 Fax: 706-595-3070 | |
Mrs. Nisha Gandhi Wilson, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 114 E Hall St, Thomson, GA 30824 Phone: 706-597-1777 | |
Janika Ivey, Counselor Medicare: Not Enrolled in Medicare Practice Location: 654 Main St Ste 6, Thomson, GA 30824 Phone: 706-595-2548 Fax: 706-595-3070 | |
Mr. Charles Edward Jones, LICENSE PROFESSIONAL Counselor Medicare: Not Enrolled in Medicare Practice Location: 114 East Hall St, Thomson, GA 30824 Phone: 706-597-1777 Fax: 706-597-0955 | |
Wanda Sanders, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 114 E Hall St, Thomson, GA 30824 Phone: 706-595-8548 | |
Lisa Modlin, LPC GEORGIA Counselor Medicare: Not Enrolled in Medicare Practice Location: 114 E Hall St, Thomson, GA 30824 Phone: 706-295-2548 | |
Shawnte Michele Wilder, Counselor Medicare: Not Enrolled in Medicare Practice Location: 654 Main St, Thomson, GA 30824 Phone: 706-595-2548 |