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1891 Santa Barbara Dr Ste 102 Lancaster PA 17601-4106 | |
| (717) 936-9758 | |
| (717) 618-6730 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 1891 Santa Barbara Dr Ste 102, Lancaster, Pennsylvania |
| Authorized Official Name and Position | Habib Ahmed (OWNER) |
| Authorized Official Contact | 6302906863 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1891 Santa Barbara Dr Ste 102 Lancaster PA 17601-4106 Ph: (717) 936-9758 | 1891 Santa Barbara Dr Ste 102 Lancaster PA 17601-4106 Ph: (717) 936-9758 |
| NPI Number | 1700586674 |
|---|---|
| Provider Enumeration Date | 03/08/2023 |
| Last Update Date | 09/08/2024 |
| Certification Date | 09/08/2024 |
| Medicare PECOS PAC ID | 7416311774 |
|---|---|
| Medicare Enrollment ID | O20230919004330 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700586674 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Matthew Brown |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699442756 PECOS PAC ID: 3971954447 Enrollment ID: I20240109002511 |
| Provider Name | Lisa Marie Mackillop |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194367706 PECOS PAC ID: 2466894514 Enrollment ID: I20240521004099 |
| Provider Name | Tosha Roberts |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1558120451 PECOS PAC ID: 9133669625 Enrollment ID: I20240911001384 |
| Provider Name | Jessica Michelle Green |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447641782 PECOS PAC ID: 0143769059 Enrollment ID: I20240917000698 |
| Provider Name | Victoria Ann Kasaczun |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720818149 PECOS PAC ID: 1456884154 Enrollment ID: I20241104000665 |
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