| Lcp Services Nc Pllc | |
|
4000 Shipyard Blvd Ste 100 Wilmington NC 28403-6194 | |
| (910) 792-5570 | |
| Not Available |
| Full Name | Lcp Services Nc Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 4000 Shipyard Blvd Ste 100, Wilmington, North Carolina |
| Authorized Official Name and Position | Whitney Danso (MANAGING MEMBER) |
| Authorized Official Contact | 8039021659 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lcp Services Nc Pllc 8508 Park Rd Ste 235 Charlotte NC 28210-5803 Ph: () - | Lcp Services Nc Pllc 4000 Shipyard Blvd Ste 100 Wilmington NC 28403-6194 Ph: (910) 792-5570 |
| NPI Number | 1366116485 |
|---|---|
| Provider Enumeration Date | 08/03/2021 |
| Last Update Date | 06/12/2024 |
| Certification Date | 06/12/2024 |
| Medicare PECOS PAC ID | 5193113033 |
|---|---|
| Medicare Enrollment ID | O20211027000498 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366116485 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Secondary |
| Provider Name | Kristen Trutt Williamson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528367984 PECOS PAC ID: 6800052705 Enrollment ID: I20120720000550 |
| Provider Name | Carolyn Craddocak |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215275201 PECOS PAC ID: 2062735418 Enrollment ID: I20141216002068 |
| Provider Name | Tanya F Bush |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619343803 PECOS PAC ID: 1052629151 Enrollment ID: I20190326000831 |
| Provider Name | Lindsay Elizabeth Hayes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700404555 PECOS PAC ID: 6507279981 Enrollment ID: I20201231001403 |
| Provider Name | Melanie Lynn Mitchell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1215342035 PECOS PAC ID: 4981921269 Enrollment ID: I20220713000714 |
| Provider Name | Joelle E Jacobs |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578091864 PECOS PAC ID: 1254792518 Enrollment ID: I20230802002967 |
| Provider Name | Gary Bruce Pate |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1780238030 PECOS PAC ID: 6204299332 Enrollment ID: I20230822004337 |
| Provider Name | David Mitchell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184015588 PECOS PAC ID: 0042653776 Enrollment ID: I20240507003491 |
| Provider Name | Deborah Perez Lopez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851046551 PECOS PAC ID: 0244671386 Enrollment ID: I20240507003771 |
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