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1435 Stuart Engals Blvd Ste 201 Mount Pleasant SC 29464-7312 | |
| (404) 788-4046 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 1435 Stuart Engals Blvd Ste 201, Mount Pleasant, South Carolina |
| Authorized Official Name and Position | John Gentry (OWNER) |
| Authorized Official Contact | 4047884046 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1904 Hubbell Dr Mount Pleasant SC 29466-9246 Ph: (404) 788-4046 | 1435 Stuart Engals Blvd Ste 201 Mount Pleasant SC 29464-7312 Ph: (404) 788-4046 |
| NPI Number | 1194449199 |
|---|---|
| Provider Enumeration Date | 10/03/2022 |
| Last Update Date | 08/23/2024 |
| Certification Date | 08/23/2024 |
| Medicare PECOS PAC ID | 5890234496 |
|---|---|
| Medicare Enrollment ID | O20240827003793 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194449199 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | John P Tressy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720596646 PECOS PAC ID: 7214359090 Enrollment ID: I20240829000868 |
| Provider Name | Lisa Marie Butcher Glavin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1538478466 PECOS PAC ID: 1153860754 Enrollment ID: I20240906001191 |
| Provider Name | Madison Taylor Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447023510 PECOS PAC ID: 6406396134 Enrollment ID: I20240909004713 |
| Provider Name | Angela Virginia Ordyniec |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770067274 PECOS PAC ID: 3870827645 Enrollment ID: I20240911002239 |
| Provider Name | Elizabeth Krzysik Sartori |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932450780 PECOS PAC ID: 1759821937 Enrollment ID: I20240914000166 |
| Provider Name | Elyse Lanier Jones |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326596065 PECOS PAC ID: 3173054616 Enrollment ID: I20241008001635 |
| Provider Name | Ryan Patrick Horn |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063979193 PECOS PAC ID: 7113451139 Enrollment ID: I20241113004655 |
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