| Centerstone Of Tennesse Inc. | |
|
3505 Village Dr Fayetteville NC 28304-4513 | |
| (615) 463-6669 | |
| (615) 653-6506 |
| Full Name | Centerstone Of Tennesse Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 3505 Village Dr, Fayetteville, North Carolina |
| Authorized Official Name and Position | Karen Lynette Keene (SECURITY OFFICER, IT TECHNOLOGY SUP) |
| Authorized Official Contact | 6154636523 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centerstone Of Tennesse Inc. Po Box 197520 Nashville TN 37219-7520 Ph: (615) 463-6669 | Centerstone Of Tennesse Inc. 3505 Village Dr Fayetteville NC 28304-4513 Ph: (615) 463-6669 |
| NPI Number | 1609482439 |
|---|---|
| Provider Enumeration Date | 09/17/2020 |
| Last Update Date | 09/17/2020 |
| Certification Date | 09/17/2020 |
| Medicare PECOS PAC ID | 9739088113 |
|---|---|
| Medicare Enrollment ID | O20210219001917 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609482439 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Quanita Q Small |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154660827 PECOS PAC ID: 0143543793 Enrollment ID: I20150106002265 |
| Provider Name | Zoe Panizzi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255769220 PECOS PAC ID: 1759519705 Enrollment ID: I20170929001180 |
| Provider Name | Kami A Perez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114479839 PECOS PAC ID: 0547504631 Enrollment ID: I20181129003177 |
| Provider Name | Victoria Lynn Mans |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114440807 PECOS PAC ID: 7517297039 Enrollment ID: I20190926001372 |
| Provider Name | Natasha Elizabeth Schauer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235651472 PECOS PAC ID: 6608204961 Enrollment ID: I20200319001960 |
| Provider Name | Matthew J Turner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144612839 PECOS PAC ID: 6507269057 Enrollment ID: I20210721004197 |
| Provider Name | Patience F Thomas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326526369 PECOS PAC ID: 7416355730 Enrollment ID: I20211018000317 |
| Provider Name | Candy Renee Tryggestad |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619457819 PECOS PAC ID: 3779972948 Enrollment ID: I20211109000942 |
| Provider Name | Diana Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821584715 PECOS PAC ID: 5890184949 Enrollment ID: I20211111001957 |
| Provider Name | Jennifer N Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013227818 PECOS PAC ID: 4183966864 Enrollment ID: I20230714000187 |
| Provider Name | David Lee Burgess |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891361507 PECOS PAC ID: 9537517370 Enrollment ID: I20231204003692 |
| Provider Name | Frankie Alan Oxendine |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1225780125 PECOS PAC ID: 5698125144 Enrollment ID: I20231222002795 |
| Provider Name | Angelina Armstrong |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467092346 PECOS PAC ID: 9133558364 Enrollment ID: I20231228002532 |
| Provider Name | Kristy Danielle Wood |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1386392918 PECOS PAC ID: 0042650558 Enrollment ID: I20240501002163 |
| Provider Name | Karen Michelle Soutullo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609247964 PECOS PAC ID: 7719327220 Enrollment ID: I20240501002331 |
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