| Credence Behavioral Health Pllc | |
|
115 Wiggington Rd Lynchburg VA 24502-4619 | |
| (434) 253-0212 | |
| Not Available |
| Full Name | Credence Behavioral Health Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 115 Wiggington Rd, Lynchburg, Virginia |
| Authorized Official Name and Position | Sanket Rajaram Dhat (CEO AND FOUNDER) |
| Authorized Official Contact | 2173814633 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Credence Behavioral Health Pllc 14803 Forest Rd Unit 2452 Forest VA 24551-9052 Ph: (434) 253-0212 | Credence Behavioral Health Pllc 115 Wiggington Rd Lynchburg VA 24502-4619 Ph: (434) 253-0212 |
| NPI Number | 1912692096 |
|---|---|
| Provider Enumeration Date | 04/06/2023 |
| Last Update Date | 06/03/2023 |
| Certification Date | 06/03/2023 |
| Medicare PECOS PAC ID | 0345606224 |
|---|---|
| Medicare Enrollment ID | O20230518002557 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912692096 | NPI | - | NPPES |
| Provider Name | Kimberly Hope Buzzelli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063794212 PECOS PAC ID: 1658545066 Enrollment ID: I20111122000072 |
| Provider Name | Sanket Rajaram Dhat |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164787701 PECOS PAC ID: 6608014733 Enrollment ID: I20160706001990 |
| Provider Name | Stephanie L Porter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023622149 PECOS PAC ID: 9638582828 Enrollment ID: I20210107000988 |
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