| Impact Counseling & Support Services Llc | |
|
1901 Manhattan Blvd Bldg D306 Harvey LA 70058-3582 | |
| (504) 250-1888 | |
| Not Available |
| Full Name | Impact Counseling & Support Services Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1901 Manhattan Blvd Bldg D306, Harvey, Louisiana |
| Authorized Official Name and Position | Tyshica Rhodes Lofton (CLINICAL DIRECTOR/CEO) |
| Authorized Official Contact | 5053016330 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Impact Counseling & Support Services Llc 308 Autumn Lakes Rd Slidell LA 70461-5106 Ph: (504) 301-6330 | Impact Counseling & Support Services Llc 1901 Manhattan Blvd Bldg D306 Harvey LA 70058-3582 Ph: (504) 250-1888 |
| NPI Number | 1639675820 |
|---|---|
| Provider Enumeration Date | 04/05/2018 |
| Last Update Date | 09/11/2023 |
| Certification Date | 09/11/2023 |
| Medicare PECOS PAC ID | 3072860196 |
|---|---|
| Medicare Enrollment ID | O20180720001333 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639675820 | NPI | - | NPPES |
| Provider Name | Stacy Marie Diliberto |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467882522 PECOS PAC ID: 7618258138 Enrollment ID: I20161221000950 |
| Provider Name | Tyshica Lofton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942656921 PECOS PAC ID: 0244587376 Enrollment ID: I20180720001520 |
| Provider Name | Andrian L Dickerson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801271028 PECOS PAC ID: 5890022115 Enrollment ID: I20210419002742 |
| Provider Name | Ashley Cross |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114203858 PECOS PAC ID: 0345638045 Enrollment ID: I20211029001561 |
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