| Lakeside Counseling And Wellness Center | |
|
900 N Swallow Tail Dr Ste 105 Port Orange FL 32129-6103 | |
| (386) 333-9717 | |
| (386) 333-9718 |
| Full Name | Lakeside Counseling And Wellness Center |
|---|---|
| Speciality | Counselor |
| Location | 900 N Swallow Tail Dr Ste 105, Port Orange, Florida |
| Authorized Official Name and Position | Patricia Adams (OWNER) |
| Authorized Official Contact | 3863339717 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Counseling And Wellness Center 900 N Swallow Tail Dr Ste 105 Port Orange FL 32129-6103 Ph: (386) 333-9717 | Lakeside Counseling And Wellness Center 900 N Swallow Tail Dr Ste 105 Port Orange FL 32129-6103 Ph: (386) 333-9717 |
| NPI Number | 1578951596 |
|---|---|
| Provider Enumeration Date | 12/29/2014 |
| Last Update Date | 03/07/2022 |
| Certification Date | 03/07/2022 |
| Medicare PECOS PAC ID | 4284955527 |
|---|---|
| Medicare Enrollment ID | O20150611001551 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578951596 | NPI | - | NPPES |
| 0213714-00 | Other | FL | 07 - MEDICAID |
| 0222423-00 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Patricia A Adams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942523378 PECOS PAC ID: 2264626548 Enrollment ID: I20101101000175 |
| Provider Name | Kelly Bowles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093259194 PECOS PAC ID: 9638451495 Enrollment ID: I20170131002085 |
| Provider Name | Nadine Heusner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114086030 PECOS PAC ID: 1951492297 Enrollment ID: I20190424000149 |
| Provider Name | Karen M Boggs |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326388620 PECOS PAC ID: 0345673117 Enrollment ID: I20191209002273 |
| Provider Name | Liana Noelle Menendez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093270290 PECOS PAC ID: 7517381262 Enrollment ID: I20200728001512 |
| Provider Name | John Townsend |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326388083 PECOS PAC ID: 1951727775 Enrollment ID: I20200811002642 |
| Provider Name | Roger Corbin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891359402 PECOS PAC ID: 7315337029 Enrollment ID: I20211210001295 |
| Provider Name | Nancy A Dawson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679206288 PECOS PAC ID: 9133501661 Enrollment ID: I20220801001060 |
| Provider Name | Katherine A Redman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174298269 PECOS PAC ID: 7810346004 Enrollment ID: I20231213002355 |
| Provider Name | Erin Rose Stephens |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851798474 PECOS PAC ID: 9537519509 Enrollment ID: I20240103002457 |
| Provider Name | Angela Yates |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548895022 PECOS PAC ID: 9931550993 Enrollment ID: I20240104000780 |
Counseling Associates Of Port Orange, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3959 S Nova Rd, Suite 5, Port Orange, FL 32127 Phone: 386-761-2390 Fax: 386-761-3256 | |
Center For Behavioral Medicine Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1730 Dunlawton Ave, Suite 3, Port Orange, FL 32127 Phone: 138-695-7390 | |
Self Quest Counseling, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3959 S Nova Rd Ste B-15, Port Orange, FL 32127 Phone: 386-566-6632 Fax: 855-471-0759 | |
Dr Anthony S Capozzi Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1730 Dunlawton Ave Ste 3, Port Orange, FL 32127 Phone: 386-957-3905 | |
Bloom Behavioral Health Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2473 Karl Dr, Port Orange, FL 32128 Phone: 904-788-9474 Fax: 760-205-4866 | |
Sue Levy Psyd Lcsw Pa Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 3959 S Nova Road, Bldg B Suite 23, Port Orange, FL 32127 Phone: 386-253-8439 Fax: 386-253-8439 | |
Grimes Neurology And Concussion Center, P.a. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 800 Dunlawton Ave Ste 103, Port Orange, FL 32127 Phone: 386-679-3270 |