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122 Gateway Blvd Ste C Mooresville NC 28117-5544 | |
| (704) 360-3637 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 122 Gateway Blvd Ste C, Mooresville, North Carolina |
| Authorized Official Name and Position | Ryan Pardo (CHIEF LEGAL OFFICER) |
| Authorized Official Contact | 2063991493 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 4962 Mooresville NC 28117-4962 Ph: () - | 122 Gateway Blvd Ste C Mooresville NC 28117-5544 Ph: (704) 360-3637 |
| NPI Number | 1447760871 |
|---|---|
| Provider Enumeration Date | 10/12/2017 |
| Last Update Date | 09/13/2024 |
| Certification Date | 09/13/2024 |
| Medicare PECOS PAC ID | 8022341494 |
|---|---|
| Medicare Enrollment ID | O20190618000993 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447760871 | NPI | - | NPPES |
| Provider Name | Denise W Logan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154693877 PECOS PAC ID: 2365422953 Enrollment ID: I20040723000473 |
| Provider Name | Christopher Fox |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336340835 PECOS PAC ID: 1759301302 Enrollment ID: I20111128000193 |
| Provider Name | Catherine A Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619050713 PECOS PAC ID: 2567650815 Enrollment ID: I20151229001834 |
| Provider Name | Safiyyah Nafeesah Feaster |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518288752 PECOS PAC ID: 8628364478 Enrollment ID: I20160906000771 |
| Provider Name | Shea Spampneto |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902274533 PECOS PAC ID: 4385986975 Enrollment ID: I20190501000794 |
| Provider Name | Katherine S Laubach |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881129484 PECOS PAC ID: 3678843224 Enrollment ID: I20210819002149 |
| Provider Name | Tyler N Edgerton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851904999 PECOS PAC ID: 5092192609 Enrollment ID: I20220520001862 |
| Provider Name | Latisha Chambers |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518670124 PECOS PAC ID: 1951752575 Enrollment ID: I20240109000266 |
| Provider Name | Courtney B Evans |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154894665 PECOS PAC ID: 0143672899 Enrollment ID: I20240117004745 |
| Provider Name | Clifford Wilson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912173956 PECOS PAC ID: 9133565195 Enrollment ID: I20240312004162 |
| Provider Name | Shannon Perry-smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922604966 PECOS PAC ID: 2961843545 Enrollment ID: I20240514001904 |
| Provider Name | Rachel Elizabeth Henderson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497994875 PECOS PAC ID: 9638614878 Enrollment ID: I20240712000853 |
| Provider Name | Robbie B Mccraw |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629600887 PECOS PAC ID: 4587100862 Enrollment ID: I20240723001971 |
| Provider Name | Sandra Lourdes Mayta |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730714163 PECOS PAC ID: 5890232979 Enrollment ID: I20240807001423 |
| Provider Name | Jillian Tuso |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720657547 PECOS PAC ID: 2264839489 Enrollment ID: I20241002003359 |
| Provider Name | Jamie Pettus |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548520125 PECOS PAC ID: 1254694839 Enrollment ID: I20241010003274 |
| Provider Name | Anna Grace Tagaram |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1790455111 PECOS PAC ID: 7214469048 Enrollment ID: I20241017000904 |
| Provider Name | Breanna Ussery |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508421694 PECOS PAC ID: 6901338433 Enrollment ID: I20241022001679 |
| Provider Name | Jearilyn Anise Singleton |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1275887382 PECOS PAC ID: 5092248948 Enrollment ID: I20241030002143 |
| Provider Name | Kimberly Carscaddon Barnett |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376310458 PECOS PAC ID: 3779016464 Enrollment ID: I20241104000083 |
| Provider Name | Amarachi Jasmine Okafor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861182735 PECOS PAC ID: 8921532169 Enrollment ID: I20241112000522 |
| Provider Name | Mocha Marie Mims |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063625432 PECOS PAC ID: 2769916808 Enrollment ID: I20241112000948 |
| Provider Name | Nicole Pinna |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548957012 PECOS PAC ID: 8729447065 Enrollment ID: I20241112001084 |
| Provider Name | Katelyn Southern Krieger |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578161469 PECOS PAC ID: 1153855937 Enrollment ID: I20241115002735 |
| Provider Name | Faith Todd Allman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114759859 PECOS PAC ID: 9335674951 Enrollment ID: I20241119004651 |
| Provider Name | Jason Matthew Mills |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447783097 PECOS PAC ID: 4880129279 Enrollment ID: I20241121003398 |
| Provider Name | Maris Autumn Williams |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811619356 PECOS PAC ID: 6305371758 Enrollment ID: I20241122001070 |
| Provider Name | Gavin Patrick Theofield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043729965 PECOS PAC ID: 1951836832 Enrollment ID: I20241202002034 |
| Provider Name | Tanya Joy Cass |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295595635 PECOS PAC ID: 4880138783 Enrollment ID: I20241203000109 |
| Provider Name | Natasha Callahan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073286241 PECOS PAC ID: 5395271183 Enrollment ID: I20241203003609 |
| Provider Name | Juliana Rose Zuccarelli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417431313 PECOS PAC ID: 0345776043 Enrollment ID: I20241204003755 |
| Provider Name | Brian Distaso |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528890704 PECOS PAC ID: 2567998289 Enrollment ID: I20241204004517 |
| Provider Name | Irene Dormenie Jackson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1053927723 PECOS PAC ID: 6901332592 Enrollment ID: I20241205002986 |
| Provider Name | Marquis Deshawn Peacock |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992202923 PECOS PAC ID: 4183150725 Enrollment ID: I20241206000526 |
| Provider Name | Stefanie Renee Mann |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487028098 PECOS PAC ID: 3971039397 Enrollment ID: I20241209004066 |
Wellness Psychiatry Group, P.c. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 249 Williamson Rd, Suite 102, Mooresville, NC 28117 Phone: 704-912-7037 | |
Pinnacle Performance Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 816 Brawley School Rd Ste F1, Mooresville, NC 28117 Phone: 704-799-1270 Fax: 704-799-1271 | |
Kristin Leigh Matas Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 107 Kilson Dr Ste 202, Mooresville, NC 28117 Phone: 704-302-6974 | |
The Center At Lake Norman Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 132 Joe Knox Ave Ste 100, Mooresville, NC 28117 Phone: 704-980-9234 Fax: 866-321-9367 | |