| Good Neighbor Outpatient Services, Inc. | |
|
9201 Arboretum Pkwy Ste 300 North Chesterfield VA 23236-5407 | |
| (855) 355-7001 | |
| (804) 251-0989 |
| Full Name | Good Neighbor Outpatient Services, Inc. |
|---|---|
| Speciality | Social Worker |
| Location | 9201 Arboretum Pkwy Ste 300, North Chesterfield, Virginia |
| Authorized Official Name and Position | Hailey Mazzei (PROGRAM DIRECTOR) |
| Authorized Official Contact | 8045204600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Good Neighbor Outpatient Services, Inc. 9201 Arboretum Pkwy Ste 300 North Chesterfield VA 23236-5407 Ph: (804) 520-4600 | Good Neighbor Outpatient Services, Inc. 9201 Arboretum Pkwy Ste 300 North Chesterfield VA 23236-5407 Ph: (855) 355-7001 |
| NPI Number | 1679871784 |
|---|---|
| Provider Enumeration Date | 03/14/2011 |
| Last Update Date | 05/24/2023 |
| Certification Date | 05/24/2023 |
| Medicare PECOS PAC ID | 0941448211 |
|---|---|
| Medicare Enrollment ID | O20130528000210 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679871784 | NPI | - | NPPES |
| 748-07-004 | Other | VA | DBHDS |
| 748-07-004 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 748-07-004 (Virginia) | Primary |
| 251S00000X | Community/behavioral Health | 748-07-004 (Virginia) | Secondary |
| Provider Name | Lloyd C Chaser |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508959982 PECOS PAC ID: 3577503028 Enrollment ID: I20050504000860 |
| Provider Name | Adam Thomas Kaul |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689653107 PECOS PAC ID: 6103080130 Enrollment ID: I20120604000159 |
| Provider Name | Carol E Drever |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487096731 PECOS PAC ID: 4486880135 Enrollment ID: I20131202000896 |
| Provider Name | Aminata Kamara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831724319 PECOS PAC ID: 0941611735 Enrollment ID: I20201130002377 |
| Provider Name | Randi Edwards |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134572985 PECOS PAC ID: 4789062118 Enrollment ID: I20220525003007 |
| Provider Name | Jonathan C Gogol |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437894748 PECOS PAC ID: 3072994995 Enrollment ID: I20220722001423 |
| Provider Name | Carolyn Kaul Cheatham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659099463 PECOS PAC ID: 9335287242 Enrollment ID: I20221103002674 |
| Provider Name | Kevin R Birdsell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215950332 PECOS PAC ID: 3072825553 Enrollment ID: I20231114000842 |
| Provider Name | Latoya Hospedales |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760909865 PECOS PAC ID: 6709238280 Enrollment ID: I20240119003397 |
| Provider Name | Jakima Bloomfield |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1902508971 PECOS PAC ID: 9032584784 Enrollment ID: I20240328003791 |
| Provider Name | Tamara Fanae'-nicholson Ferebee |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871740639 PECOS PAC ID: 3476992603 Enrollment ID: I20240508004176 |
| Provider Name | Demetrius Biggs |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154178440 PECOS PAC ID: 9234571456 Enrollment ID: I20240520002661 |
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