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355 Crawford St Ste 816 Portsmouth VA 23704-2825 | |
| (757) 966-2715 | |
| (757) 432-2971 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 355 Crawford St Ste 816, Portsmouth, Virginia |
| Authorized Official Name and Position | Jennifer Cortes Morgan (OWNER) |
| Authorized Official Contact | 7579662715 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
355 Crawford St Ste 816 Portsmouth VA 23704-2825 Ph: (757) 966-2715 | 355 Crawford St Ste 816 Portsmouth VA 23704-2825 Ph: (757) 966-2715 |
| NPI Number | 1275154700 |
|---|---|
| Provider Enumeration Date | 05/06/2020 |
| Last Update Date | 09/20/2021 |
| Certification Date | 09/20/2021 |
| Medicare PECOS PAC ID | 8729522727 |
|---|---|
| Medicare Enrollment ID | O20240702000287 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275154700 | NPI | - | NPPES |
| 1710466354 | Other | VA | ANTHEM |
| 1710466354 | Other | VA | CIGNA |
| 1710466354 | Other | VA | UNITED HEALTHCARE |
| 1710466354 | Other | VA | HUMANA-TRICARE |
| 1710466354 | Other | VA | OPTIMA |
| 1710466354 | Other | VA | AETNA |
| 1710466354 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Jennifer Cortes Morgan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1710466354 PECOS PAC ID: 6800330804 Enrollment ID: I20240702000418 |
| Provider Name | Laura Fales |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1255957965 PECOS PAC ID: 7618411612 Enrollment ID: I20240702004517 |
| Provider Name | Antoine Nichols |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1265910525 PECOS PAC ID: 5395285928 Enrollment ID: I20240910004125 |
| Provider Name | Sydney Beasley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487487120 PECOS PAC ID: 5496280562 Enrollment ID: I20241126002639 |
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