| Brook Lane Behavioral Services, Inc. | |
|
13215 Brook Lane Outpatient Services Hagerstown MD 21742 | |
| (301) 733-0330 | |
| (240) 310-1927 |
| Full Name | Brook Lane Behavioral Services, Inc. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 13215 Brook Lane, Hagerstown, Maryland |
| Authorized Official Name and Position | Michael Christopher Hann (CMO) |
| Authorized Official Contact | 3017330331 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brook Lane Behavioral Services, Inc. 13121 Brook Lane Hagerstown MD 21742 Ph: (301) 733-0330 | Brook Lane Behavioral Services, Inc. 13215 Brook Lane Outpatient Services Hagerstown MD 21742 Ph: (301) 733-0330 |
| NPI Number | 1538647748 |
|---|---|
| Provider Enumeration Date | 07/31/2018 |
| Last Update Date | 06/16/2023 |
| Certification Date | 06/16/2023 |
| Medicare PECOS PAC ID | 5991055022 |
|---|---|
| Medicare Enrollment ID | O20180911000549 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538647748 | NPI | - | NPPES |
| Provider Name | Susan Boyd |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164431516 PECOS PAC ID: 0042204620 Enrollment ID: I20040414001477 |
| Provider Name | Susan Corley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932170594 PECOS PAC ID: 4688629108 Enrollment ID: I20050317000670 |
| Provider Name | Vicki S Churchey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023105483 PECOS PAC ID: 9234167487 Enrollment ID: I20050729000537 |
| Provider Name | John E Burke |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1114992427 PECOS PAC ID: 1951469295 Enrollment ID: I20081015000442 |
| Provider Name | John H Carrill |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821063124 PECOS PAC ID: 3577621945 Enrollment ID: I20081029000463 |
| Provider Name | Corvin V Robinson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548244841 PECOS PAC ID: 0244216927 Enrollment ID: I20090217000206 |
| Provider Name | Maximilian Badoy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902954902 PECOS PAC ID: 5991795791 Enrollment ID: I20090331000416 |
| Provider Name | Michelle K Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417928086 PECOS PAC ID: 7012064306 Enrollment ID: I20090402000011 |
| Provider Name | Donna J Fogle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982828448 PECOS PAC ID: 0941340194 Enrollment ID: I20091218000180 |
| Provider Name | Nancy Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205803707 PECOS PAC ID: 6406998301 Enrollment ID: I20100114000724 |
| Provider Name | Tiesha Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104082346 PECOS PAC ID: 4385770478 Enrollment ID: I20100329000031 |
| Provider Name | Christine N Kitchen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295935617 PECOS PAC ID: 0648463901 Enrollment ID: I20101019000645 |
| Provider Name | Jamal K Fawaz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003881335 PECOS PAC ID: 4981899614 Enrollment ID: I20101108001219 |
| Provider Name | Olga Demina |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467633768 PECOS PAC ID: 9537236500 Enrollment ID: I20110926000114 |
| Provider Name | Andrew Johnson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972584233 PECOS PAC ID: 1052483112 Enrollment ID: I20111108000478 |
| Provider Name | Janell K Budgett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346526050 PECOS PAC ID: 8426223272 Enrollment ID: I20111207000161 |
| Provider Name | Gratia Johns Boehme |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386672202 PECOS PAC ID: 1759384266 Enrollment ID: I20120202000590 |
| Provider Name | Richard B Rothman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750558045 PECOS PAC ID: 6901067842 Enrollment ID: I20120419000585 |
| Provider Name | Sarah B Schiffres-grove |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194090555 PECOS PAC ID: 8224299003 Enrollment ID: I20120423000517 |
| Provider Name | Jenny C Mcfarland |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578538310 PECOS PAC ID: 9638332455 Enrollment ID: I20120515000217 |
| Provider Name | Rena V Arnold |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174808273 PECOS PAC ID: 1850554262 Enrollment ID: I20120523000065 |
| Provider Name | David Gonzalez-cawley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144295981 PECOS PAC ID: 9638333297 Enrollment ID: I20120611000374 |
| Provider Name | Lauree K Wolford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659623924 PECOS PAC ID: 3072768878 Enrollment ID: I20130228000226 |
| Provider Name | Laura L Ebner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497998652 PECOS PAC ID: 6507008273 Enrollment ID: I20130808000323 |
| Provider Name | Robin D Morris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649554668 PECOS PAC ID: 0941435119 Enrollment ID: I20131023001510 |
| Provider Name | Jenna R Garner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174954028 PECOS PAC ID: 6709015001 Enrollment ID: I20140207001473 |
| Provider Name | Alexander I Dever |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568444396 PECOS PAC ID: 6507819836 Enrollment ID: I20140317000101 |
| Provider Name | Nkem Zos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811317472 PECOS PAC ID: 4183849730 Enrollment ID: I20140715002143 |
| Provider Name | Casey Crouch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811324395 PECOS PAC ID: 6709004534 Enrollment ID: I20140820000971 |
| Provider Name | James A Schiller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932511714 PECOS PAC ID: 5193046217 Enrollment ID: I20150602000229 |
| Provider Name | Anna K Elwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740679067 PECOS PAC ID: 1153614672 Enrollment ID: I20160721000824 |
| Provider Name | Lynn S Feldman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609979764 PECOS PAC ID: 8022109297 Enrollment ID: I20160816001143 |
| Provider Name | Amanda Bond |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912381112 PECOS PAC ID: 9234424383 Enrollment ID: I20160829000914 |
| Provider Name | Jessie L Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528436078 PECOS PAC ID: 7416237854 Enrollment ID: I20161201000711 |
| Provider Name | Jeanne Olson Reed |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184964942 PECOS PAC ID: 7517105703 Enrollment ID: I20170225000281 |
| Provider Name | Michael P Shea |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730195629 PECOS PAC ID: 9133378623 Enrollment ID: I20170926000141 |
| Provider Name | Sarah Wempe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447621925 PECOS PAC ID: 4183980147 Enrollment ID: I20171107001882 |
| Provider Name | Shawna Angel Chisholm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679091524 PECOS PAC ID: 4486911385 Enrollment ID: I20171201000240 |
| Provider Name | Kaitlin E Carlson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932653086 PECOS PAC ID: 2668733056 Enrollment ID: I20180227002266 |
| Provider Name | Phoebe Antoinette Underwood-davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457844722 PECOS PAC ID: 6800148123 Enrollment ID: I20181015000317 |
| Provider Name | Lindsey J Burd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932683885 PECOS PAC ID: 8921352915 Enrollment ID: I20181109001400 |
| Provider Name | Christopher Wheatley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063969806 PECOS PAC ID: 8628353851 Enrollment ID: I20190122001833 |
| Provider Name | Amy R Baker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538468061 PECOS PAC ID: 4981946787 Enrollment ID: I20190426001146 |
| Provider Name | Hara Oyedeji |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497279053 PECOS PAC ID: 4385986850 Enrollment ID: I20190502001278 |
| Provider Name | Kelly F Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669946984 PECOS PAC ID: 1557603925 Enrollment ID: I20190506000163 |
| Provider Name | Debra Ambrose |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518193416 PECOS PAC ID: 5991858615 Enrollment ID: I20190522003014 |
| Provider Name | Veronica D Morton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699049460 PECOS PAC ID: 2062671274 Enrollment ID: I20190603002929 |
| Provider Name | Christabel Lartey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962762237 PECOS PAC ID: 4688928484 Enrollment ID: I20191003001475 |
| Provider Name | Nicole Renee Ennis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659925717 PECOS PAC ID: 2668800830 Enrollment ID: I20200323000070 |
| Provider Name | Tina M Noone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144604323 PECOS PAC ID: 4688989957 Enrollment ID: I20200323000131 |
| Provider Name | Aisha Reikow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699196527 PECOS PAC ID: 6507099728 Enrollment ID: I20200421003222 |
| Provider Name | Amy C Fehrmann |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942695291 PECOS PAC ID: 1456659770 Enrollment ID: I20200804000610 |
| Provider Name | James Lukas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083120687 PECOS PAC ID: 8224383492 Enrollment ID: I20201216000051 |
| Provider Name | Christaina Wabeke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801439146 PECOS PAC ID: 1759714686 Enrollment ID: I20210623000929 |
| Provider Name | Jamie Mathewson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346804879 PECOS PAC ID: 0345641023 Enrollment ID: I20210701002608 |
| Provider Name | Trevor Rishawn Marquis York |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174054456 PECOS PAC ID: 6608112370 Enrollment ID: I20210706003490 |
| Provider Name | Willis Leavitt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700876588 PECOS PAC ID: 2062703150 Enrollment ID: I20210819001203 |
| Provider Name | Gwendolyn Mellott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124094602 PECOS PAC ID: 1153727284 Enrollment ID: I20210915000186 |
| Provider Name | Katherine E Loutrel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114412301 PECOS PAC ID: 1254738354 Enrollment ID: I20210915003511 |
| Provider Name | Janevine Nkiru Onyeanuna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386205953 PECOS PAC ID: 1759788698 Enrollment ID: I20210921000356 |
| Provider Name | Tayler Rowe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649805979 PECOS PAC ID: 2466841044 Enrollment ID: I20211122000058 |
| Provider Name | Andrea Charlotte Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588327191 PECOS PAC ID: 4183010952 Enrollment ID: I20220404000596 |
| Provider Name | Michael Christopher Hann |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649511486 PECOS PAC ID: 7719371012 Enrollment ID: I20220513000838 |
| Provider Name | Dawn Jenkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144451568 PECOS PAC ID: 4981731742 Enrollment ID: I20221018002154 |
| Provider Name | Carrie Elizabeth Lewis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790196814 PECOS PAC ID: 3577930262 Enrollment ID: I20221109002667 |
| Provider Name | Noelle Pierce |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316520836 PECOS PAC ID: 2567829831 Enrollment ID: I20230531002682 |
| Provider Name | Lisandra Lysaith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356082804 PECOS PAC ID: 3476900838 Enrollment ID: I20231107003852 |
| Provider Name | Mary Elizabeth Demartino |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295054096 PECOS PAC ID: 4082062955 Enrollment ID: I20231204000641 |
| Provider Name | Shannon Lynn Bell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114422565 PECOS PAC ID: 0840649273 Enrollment ID: I20231211003684 |
| Provider Name | Karley Hensley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649411075 PECOS PAC ID: 9931398492 Enrollment ID: I20231222001750 |
| Provider Name | Jessica E Dorsey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275294910 PECOS PAC ID: 2860842820 Enrollment ID: I20240103001912 |
| Provider Name | Emily Collingham |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1962890962 PECOS PAC ID: 1759732787 Enrollment ID: I20240103004722 |
| Provider Name | Tamara Huff |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770558017 PECOS PAC ID: 0345691010 Enrollment ID: I20240106000017 |
| Provider Name | Stephen J. Defino |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457746943 PECOS PAC ID: 4789035452 Enrollment ID: I20240106000076 |
| Provider Name | Sabrina A Mccauley Shriver |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1700414083 PECOS PAC ID: 3375994999 Enrollment ID: I20240109000437 |
| Provider Name | Rida Faridi |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1164096582 PECOS PAC ID: 2860843315 Enrollment ID: I20240109001813 |
| Provider Name | Cory Matthew Shives |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699218461 PECOS PAC ID: 5294186748 Enrollment ID: I20240109001925 |
| Provider Name | Melissa D Crigger |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1558715185 PECOS PAC ID: 2062863566 Enrollment ID: I20240109003693 |
| Provider Name | Christine Marie Edell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831585165 PECOS PAC ID: 1052762325 Enrollment ID: I20240111000514 |
| Provider Name | Jeffery D. O'neal |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326024324 PECOS PAC ID: 5092109397 Enrollment ID: I20240111003051 |
| Provider Name | Nasrene Elizabeth Nikpora |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1366091126 PECOS PAC ID: 3678924859 Enrollment ID: I20240111004802 |
| Provider Name | Melanie Anne Racey Brady |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1508930553 PECOS PAC ID: 5395197206 Enrollment ID: I20240116003923 |
| Provider Name | Toby Allison Long |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1962927350 PECOS PAC ID: 0042662967 Enrollment ID: I20240116004640 |
| Provider Name | Creston Zane Baker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912138835 PECOS PAC ID: 7810225778 Enrollment ID: I20240122003495 |
| Provider Name | Danielle Roncone |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154521896 PECOS PAC ID: 9436510096 Enrollment ID: I20240124000713 |
| Provider Name | Heather Marie Petro |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1619475647 PECOS PAC ID: 2264885136 Enrollment ID: I20240126001490 |
| Provider Name | Kenneth Saad |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912107335 PECOS PAC ID: 4981047149 Enrollment ID: I20240205004347 |
| Provider Name | Mark Andrew Conrad |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235546284 PECOS PAC ID: 5496198566 Enrollment ID: I20240206000368 |
| Provider Name | Meateran A Funwi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407522451 PECOS PAC ID: 9133562218 Enrollment ID: I20240206000723 |
| Provider Name | Allyson Suzanne Lawson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245588532 PECOS PAC ID: 0648613745 Enrollment ID: I20240206001222 |
| Provider Name | Krista Marie Gordon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023766052 PECOS PAC ID: 5092158196 Enrollment ID: I20240206001286 |
| Provider Name | Lawrence Reed Holmes |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1558872713 PECOS PAC ID: 2163865148 Enrollment ID: I20240206004571 |
| Provider Name | Mary Beth Noble |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649624198 PECOS PAC ID: 2264875277 Enrollment ID: I20240207000485 |
| Provider Name | Morgan Welch |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841901386 PECOS PAC ID: 6002259041 Enrollment ID: I20240207001507 |
| Provider Name | Greg William Johnson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154416485 PECOS PAC ID: 8426493669 Enrollment ID: I20240228000750 |
| Provider Name | Margaret Louise Wishard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891355749 PECOS PAC ID: 6901241066 Enrollment ID: I20240228001852 |
| Provider Name | Jade Angeline Brenneman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053080135 PECOS PAC ID: 2466898879 Enrollment ID: I20240307003006 |
| Provider Name | Stacey C. Wilson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851746036 PECOS PAC ID: 6305284019 Enrollment ID: I20240401001409 |
| Provider Name | Robert William Vinson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851946115 PECOS PAC ID: 0749629699 Enrollment ID: I20240411004183 |
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