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6465 College Park Sq Ste 300 Va Beach VA 23464-3622 | |
(757) 351-0057 | |
(757) 351-6890 |
Full Name | |
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Speciality | Clinic/Center |
Location | 6465 College Park Sq Ste 300, Va Beach, Virginia |
Authorized Official Name and Position | Morgan Brianna Ketner-white (CEO, PRESIDENT) |
Authorized Official Contact | 7573510057 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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6465 College Park Sq Ste 300 Va Beach VA 23464-3622 Ph: (757) 351-0005 | 6465 College Park Sq Ste 300 Va Beach VA 23464-3622 Ph: (757) 351-0057 |
NPI Number | 1619340858 |
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Provider Enumeration Date | 11/10/2015 |
Last Update Date | 09/16/2024 |
Certification Date | 09/16/2024 |
Medicare PECOS PAC ID | 2163964925 |
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Medicare Enrollment ID | O20240607001250 |
Identifier | Type | State | Issuer |
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1619340858 | NPI | - | NPPES |
30017483470002 | Medicaid | VA | |
16186 | Medicaid | VA | |
30017483470001 | Medicaid | VA |
Provider Name | Lena Villanueva |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1912617812 PECOS PAC ID: 0143691741 Enrollment ID: I20230118001833 |
Provider Name | Shelly Marie Rodgers |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1790567394 PECOS PAC ID: 3072055839 Enrollment ID: I20240607001338 |
Provider Name | Morgan Brianna Ketner-white |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1619759297 PECOS PAC ID: 7517409378 Enrollment ID: I20240607001677 |
Futures Counseling Corporation Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 900 Commonwealth Pl Ste 200, Va Beach, VA 23464 Phone: 757-353-9616 Fax: 757-313-6634 | |
New Family Horizons Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 807b Monroe Ct, Va Beach, VA 23464 Phone: 240-416-5542 |