| Gardenia Cove Mental Health Pc | |
|
6771 Taylor Circle Montgomery AL 36117 | |
| (334) 954-6010 | |
| Not Available |
| Full Name | Gardenia Cove Mental Health Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6771 Taylor Circle, Montgomery, Alabama |
| Authorized Official Name and Position | Amanda Jean Williams (OWNER, MD) |
| Authorized Official Contact | 3349546010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gardenia Cove Mental Health Pc 6771 Taylor Cir Montgomery AL 36117-3417 Ph: (334) 954-6010 | Gardenia Cove Mental Health Pc 6771 Taylor Circle Montgomery AL 36117 Ph: (334) 954-6010 |
| NPI Number | 1063912301 |
|---|---|
| Provider Enumeration Date | 02/13/2018 |
| Last Update Date | 02/13/2018 |
| Medicare PECOS PAC ID | 0648534537 |
|---|---|
| Medicare Enrollment ID | O20180430002176 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063912301 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | MD.34291 (Alabama) | Primary |
| Provider Name | Amanda J Williams |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740577840 PECOS PAC ID: 0648588855 Enrollment ID: I20151112000439 |
| Provider Name | Jessaka Fife |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891900957 PECOS PAC ID: 3678879269 Enrollment ID: I20160308001463 |
| Provider Name | Rachel Liner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952878340 PECOS PAC ID: 0749529139 Enrollment ID: I20190301000586 |
| Provider Name | Brady Eugene Beziat |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184132201 PECOS PAC ID: 5597006858 Enrollment ID: I20190415001266 |
| Provider Name | Aubrey N Carpenter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487215844 PECOS PAC ID: 1153650775 Enrollment ID: I20190906003301 |
| Provider Name | Leigh A Fagin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114568508 PECOS PAC ID: 0345676912 Enrollment ID: I20200130002492 |
| Provider Name | Nicole A Dean |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780218818 PECOS PAC ID: 8123449840 Enrollment ID: I20200605000513 |
| Provider Name | Will Rutland |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194256271 PECOS PAC ID: 9032480819 Enrollment ID: I20201203002218 |
| Provider Name | William Earnest |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184230377 PECOS PAC ID: 0648683151 Enrollment ID: I20201230000431 |
| Provider Name | Megan Ferrell |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1780272765 PECOS PAC ID: 3072928936 Enrollment ID: I20210226002200 |
| Provider Name | Victoria Tisdale |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467932921 PECOS PAC ID: 8628483500 Enrollment ID: I20210301000203 |
| Provider Name | Jennifer Michelle Venable-humphrey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588781322 PECOS PAC ID: 8820492952 Enrollment ID: I20210811001231 |
| Provider Name | Alesha R Thomas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538795851 PECOS PAC ID: 9234510553 Enrollment ID: I20220718003798 |
| Provider Name | Arthur E Mallory |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033830237 PECOS PAC ID: 8325424658 Enrollment ID: I20221010002513 |
| Provider Name | Sakia G Dixon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942926217 PECOS PAC ID: 1850760786 Enrollment ID: I20221215000283 |
| Provider Name | Emily L Hopkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780317156 PECOS PAC ID: 6800267600 Enrollment ID: I20230113000121 |
| Provider Name | Bradley Scott Edmonds |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477073971 PECOS PAC ID: 9335405588 Enrollment ID: I20240116000295 |
| Provider Name | Jamie M Pruitt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841291663 PECOS PAC ID: 2466891445 Enrollment ID: I20240424000599 |
| Provider Name | Jill M Sexton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922570043 PECOS PAC ID: 0446690432 Enrollment ID: I20240424001055 |
| Provider Name | Maryanna E Manderville |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285916593 PECOS PAC ID: 5890135891 Enrollment ID: I20240424001550 |
| Provider Name | Jason S Orrock |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1881033850 PECOS PAC ID: 6305286303 Enrollment ID: I20240424001712 |
| Provider Name | Kyle M Flaherty |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598014748 PECOS PAC ID: 8729428750 Enrollment ID: I20240424002764 |
| Provider Name | Derrick C Manora |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205334356 PECOS PAC ID: 8729429931 Enrollment ID: I20240517002322 |
| Provider Name | Mckenzie K Litaker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093561409 PECOS PAC ID: 2769824671 Enrollment ID: I20240523001843 |
| Provider Name | Elizabeth K Mitchell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396449245 PECOS PAC ID: 2264874908 Enrollment ID: I20240524003040 |
| Provider Name | Laura E Porter-morris |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649879131 PECOS PAC ID: 5799127437 Enrollment ID: I20240524003112 |
| Provider Name | Lekesha R Wyse |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1083397137 PECOS PAC ID: 2769824408 Enrollment ID: I20240524003188 |
| Provider Name | Austin M Isler |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235982323 PECOS PAC ID: 3375985872 Enrollment ID: I20240530000007 |
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