| Heatherwood Counseling Center | |
|
434 Mitchell Valley Dr Marion VA 24354-6338 | |
| (276) 783-7600 | |
| (276) 783-1802 |
| Full Name | Heatherwood Counseling Center |
|---|---|
| Speciality | Social Worker |
| Location | 434 Mitchell Valley Dr, Marion, Virginia |
| Authorized Official Name and Position | Patricia B Conklin (LICENSED CLIN. SW/OWNER) |
| Authorized Official Contact | 2767837600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heatherwood Counseling Center 434 Mitchell Valley Dr Marion VA 24354-6338 Ph: (276) 783-7600 | Heatherwood Counseling Center 434 Mitchell Valley Dr Marion VA 24354-6338 Ph: (276) 783-7600 |
| NPI Number | 1780614594 |
|---|---|
| Provider Enumeration Date | 07/04/2006 |
| Last Update Date | 11/30/2016 |
| Medicare PECOS PAC ID | 9133100605 |
|---|---|
| Medicare Enrollment ID | O20040528001201 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780614594 | NPI | - | NPPES |
| C07092 | Other | VA | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 0904000865 (Virginia) | Primary |
| Provider Name | Christopher M Carusi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689766784 PECOS PAC ID: 1850326927 Enrollment ID: I20050928000646 |
| Provider Name | Gary F Lyons |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093731028 PECOS PAC ID: 2163467069 Enrollment ID: I20090217000169 |
| Provider Name | Patricia Banks Conklin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265454169 PECOS PAC ID: 2668669086 Enrollment ID: I20110523000804 |
| Provider Name | James Henry Bangle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952416406 PECOS PAC ID: 6709054091 Enrollment ID: I20110712000098 |
| Provider Name | Debra S Parks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720351224 PECOS PAC ID: 5496914228 Enrollment ID: I20120314000006 |
| Provider Name | Jason D Poston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841635380 PECOS PAC ID: 6002057692 Enrollment ID: I20130724000372 |
| Provider Name | Melissa Dye |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881092211 PECOS PAC ID: 2466764972 Enrollment ID: I20150710002058 |
| Provider Name | Deborah Jean Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881920395 PECOS PAC ID: 3375855869 Enrollment ID: I20150713001276 |
| Provider Name | Michelle Guy Debord |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316052657 PECOS PAC ID: 2163730664 Enrollment ID: I20151002001213 |
| Provider Name | Zetta K Bowles |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1992832547 PECOS PAC ID: 8022378058 Enrollment ID: I20180212001599 |
| Provider Name | Laura Campbell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295178879 PECOS PAC ID: 5092077974 Enrollment ID: I20180314000253 |
| Provider Name | Robert Baranowsky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407305055 PECOS PAC ID: 6709121718 Enrollment ID: I20181219003299 |
| Provider Name | Leanne Hyler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568050946 PECOS PAC ID: 3375956246 Enrollment ID: I20210208001780 |
| Provider Name | Gay Holbrook |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396084026 PECOS PAC ID: 4183075054 Enrollment ID: I20240105000435 |
| Provider Name | Troy A Bise |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982155685 PECOS PAC ID: 7618238031 Enrollment ID: I20240112000199 |
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