| Coastal Samaritan Counseling Center | |
|
1297 Professional Drive Ste 101 Myrtle Beach SC 29577-5713 | |
| (843) 448-4820 | |
| (843) 448-9875 |
| Full Name | Coastal Samaritan Counseling Center |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1297 Professional Drive, Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Lisa Ann Kroneker (OFFICE ADMINISTRATOR) |
| Authorized Official Contact | 8434484820 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Samaritan Counseling Center 1297 Professional Drive Ste 101 Myrtle Beach SC 29577-5713 Ph: (843) 448-4820 | Coastal Samaritan Counseling Center 1297 Professional Drive Ste 101 Myrtle Beach SC 29577-5713 Ph: (843) 448-4820 |
| NPI Number | 1922189679 |
|---|---|
| Provider Enumeration Date | 10/18/2006 |
| Last Update Date | 01/31/2024 |
| Medicare PECOS PAC ID | 9537348487 |
|---|---|
| Medicare Enrollment ID | O20110124000992 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922189679 | NPI | - | NPPES |
| GP7630 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Debra Carnosso |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194891127 PECOS PAC ID: 3476643594 Enrollment ID: I20150616000029 |
| Provider Name | Carol Ann Fletcher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295952232 PECOS PAC ID: 8426207895 Enrollment ID: I20161219000421 |
| Provider Name | Lester C Robinette |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932566817 PECOS PAC ID: 4587902499 Enrollment ID: I20190218002792 |
| Provider Name | Andrew Sone |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801159108 PECOS PAC ID: 7416290416 Enrollment ID: I20190514003066 |
| Provider Name | June Tyson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902056211 PECOS PAC ID: 0446560403 Enrollment ID: I20211019002204 |
| Provider Name | Carol Jane Osment |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154649986 PECOS PAC ID: 3173749751 Enrollment ID: I20240201001656 |
| Provider Name | Kelly S Gilmer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629689237 PECOS PAC ID: 1254774714 Enrollment ID: I20240212002995 |
| Provider Name | Stacy E Fraser |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285130625 PECOS PAC ID: 3971949470 Enrollment ID: I20240306003723 |
| Provider Name | Carmen L Royall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114002490 PECOS PAC ID: 6507206778 Enrollment ID: I20240506000252 |
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