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3613 Williams Dr Ste 302 Georgetown TX 78628-1369 | |
| (512) 713-9886 | |
| (737) 277-5546 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 3613 Williams Dr Ste 302, Georgetown, Texas |
| Authorized Official Name and Position | Candi Gadison (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5127139886 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3613 Williams Dr Ste 302 Georgetown TX 78628-1369 Ph: (512) 713-9886 | 3613 Williams Dr Ste 302 Georgetown TX 78628-1369 Ph: (512) 713-9886 |
| NPI Number | 1396312658 |
|---|---|
| Provider Enumeration Date | 06/07/2021 |
| Last Update Date | 07/08/2022 |
| Certification Date | 07/08/2022 |
| Medicare PECOS PAC ID | 4284167438 |
|---|---|
| Medicare Enrollment ID | O20241028001387 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396312658 | NPI | - | NPPES |
| NONE | Other | TX | N/A |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Candi L. Gadison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265735302 PECOS PAC ID: 7416480587 Enrollment ID: I20241028002792 |
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