| Kingwood Counseling Center Pllc | |
|
1521 Green Oak Pl Ste 250 Kingwood TX 77339-2044 | |
| (281) 608-1346 | |
| (832) 436-1648 |
| Full Name | Kingwood Counseling Center Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 1521 Green Oak Pl Ste 250, Kingwood, Texas |
| Authorized Official Name and Position | Donna Marie Bullard (OFFICE MANAGER) |
| Authorized Official Contact | 3233478128 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kingwood Counseling Center Pllc 1521 Green Oak Pl Ste 250 Kingwood TX 77339-2044 Ph: (281) 608-1346 | Kingwood Counseling Center Pllc 1521 Green Oak Pl Ste 250 Kingwood TX 77339-2044 Ph: (281) 608-1346 |
| NPI Number | 1124639489 |
|---|---|
| Provider Enumeration Date | 08/11/2020 |
| Last Update Date | 10/19/2020 |
| Certification Date | 10/19/2020 |
| Medicare PECOS PAC ID | 8426477134 |
|---|---|
| Medicare Enrollment ID | O20200930000802 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124639489 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Sydney A Ordonio |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801864863 PECOS PAC ID: 6800898404 Enrollment ID: I20070212000246 |
| Provider Name | Adia Nishati Naba |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093038622 PECOS PAC ID: 8123159712 Enrollment ID: I20180822001331 |
| Provider Name | Rachel S Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700108958 PECOS PAC ID: 4486927936 Enrollment ID: I20190626000334 |
| Provider Name | Lakeesha Joyce Carroll |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215668777 PECOS PAC ID: 1951747682 Enrollment ID: I20240315002126 |
| Provider Name | Stephen Gregory Williams |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245942788 PECOS PAC ID: 8921445776 Enrollment ID: I20240328001439 |
| Provider Name | Hamdalat M Ekemode |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922717867 PECOS PAC ID: 2860831500 Enrollment ID: I20240415002413 |
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