Cp Specialized Services Llc | |
251 River Park North Dr Woodstock GA 30188-7835 | |
(678) 557-5996 | |
Not Available |
Full Name | Cp Specialized Services Llc |
---|---|
Speciality | Counselor |
Location | 251 River Park North Dr, Woodstock, Georgia |
Authorized Official Name and Position | Colleen Pearl Panunzio (PROVIDER) |
Authorized Official Contact | 6785575996 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Cp Specialized Services Llc 251 River Park North Dr Woodstock GA 30188-7835 Ph: (678) 557-5996 | Cp Specialized Services Llc 251 River Park North Dr Woodstock GA 30188-7835 Ph: (678) 557-5996 |
NPI Number | 1205698636 |
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Provider Enumeration Date | 01/30/2024 |
Last Update Date | 01/30/2024 |
Certification Date | 01/30/2024 |
Medicare PECOS PAC ID | 1557704954 |
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Medicare Enrollment ID | O20240213000241 |
Identifier | Type | State | Issuer |
---|---|---|---|
1205698636 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101Y00000X | Counselor | (* (Not Available)) | Primary |
Provider Name | Colleen P Panunzio |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1821080102 PECOS PAC ID: 4284077686 Enrollment ID: I20240213000361 |
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