| Central Counseling Services Licensed Clinical Social Worker Inc | |
|
6840 Indiana Ave Ste 275 Riverside CA 92506-4279 | |
| (951) 778-0230 | |
| Not Available |
| Full Name | Central Counseling Services Licensed Clinical Social Worker Inc |
|---|---|
| Speciality | Social Worker |
| Location | 6840 Indiana Ave Ste 275, Riverside, California |
| Authorized Official Name and Position | Sheralyn L. Shockey-pope (CHIEF OPERATION OFFICER) |
| Authorized Official Contact | 9517780230 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Central Counseling Services Licensed Clinical Social Worker Inc 6840 Indiana Ave Ste 275 Riverside CA 92506-4279 Ph: (951) 778-0230 | Central Counseling Services Licensed Clinical Social Worker Inc 6840 Indiana Ave Ste 275 Riverside CA 92506-4279 Ph: (951) 778-0230 |
| NPI Number | 1043704331 |
|---|---|
| Provider Enumeration Date | 06/19/2018 |
| Last Update Date | 02/05/2020 |
| Certification Date | 02/05/2020 |
| Medicare PECOS PAC ID | 2365886363 |
|---|---|
| Medicare Enrollment ID | O20240219000123 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043704331 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 26872 (California) | Primary |
| 106H00000X | Marriage & Family Therapist | 37209 (California) | Secondary |
| Provider Name | Tracy L Shockey-pope |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427136712 PECOS PAC ID: 7618112582 Enrollment ID: I20130325000259 |
| Provider Name | Sheralyn Lee Shockey-pope |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1598035099 PECOS PAC ID: 6901240902 Enrollment ID: I20240219000537 |
| Provider Name | Ilse Aerts |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1174975155 PECOS PAC ID: 3476997339 Enrollment ID: I20240219002725 |
| Provider Name | Jill A. Johnson-young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083991293 PECOS PAC ID: 5092159095 Enrollment ID: I20240318002771 |
| Provider Name | Colleen Duggin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407363120 PECOS PAC ID: 6901245703 Enrollment ID: I20240412001515 |
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