| Lake Country Counseling Llc | |
|
516 W Atlantic St South Hill VA 23970-1906 | |
| (434) 774-7559 | |
| (434) 447-3579 |
| Full Name | Lake Country Counseling Llc |
|---|---|
| Speciality | Social Worker |
| Location | 516 W Atlantic St, South Hill, Virginia |
| Authorized Official Name and Position | Tessie S Smith (LIC CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 4347747559 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Country Counseling Llc 516 W Atlantic St South Hill VA 23970-1906 Ph: (434) 774-7559 | Lake Country Counseling Llc 516 W Atlantic St South Hill VA 23970-1906 Ph: (434) 774-7559 |
| NPI Number | 1871006817 |
|---|---|
| Provider Enumeration Date | 11/13/2017 |
| Last Update Date | 11/13/2017 |
| Medicare PECOS PAC ID | 2365702388 |
|---|---|
| Medicare Enrollment ID | O20180212001372 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871006817 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 0904006071 (Virginia) | Primary |
| Provider Name | Tessie S Sadler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184792384 PECOS PAC ID: 2466488788 Enrollment ID: I20050708000619 |
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