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8045 Arco Corporate Dr Raleigh NC 27617-2025 | |
| (919) 397-4592 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 8045 Arco Corporate Dr, Raleigh, North Carolina |
| Authorized Official Name and Position | Michael Peet (CFO) |
| Authorized Official Contact | 9193974592 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
8045 Arco Corporate Dr Ste 120 Raleigh NC 27617-2026 Ph: () - | 8045 Arco Corporate Dr Raleigh NC 27617-2025 Ph: (919) 397-4592 |
| NPI Number | 1194595512 |
|---|---|
| Provider Enumeration Date | 01/05/2024 |
| Last Update Date | 01/19/2025 |
| Certification Date | 01/19/2025 |
| Medicare PECOS PAC ID | 1557806338 |
|---|---|
| Medicare Enrollment ID | O20240717000331 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194595512 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Ian Gabriel Collins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760843486 PECOS PAC ID: 9638614415 Enrollment ID: I20240717000576 |
| Provider Name | Jennifer Ross Woodson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245620061 PECOS PAC ID: 2062944838 Enrollment ID: I20241017002677 |
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