| Old Towne Counseling Services, Llc | |
|
7293 Shady Grove Rd Mechanicsville VA 23111-2129 | |
| (804) 398-8401 | |
| (866) 499-8549 |
| Full Name | Old Towne Counseling Services, Llc |
|---|---|
| Speciality | Counselor |
| Location | 7293 Shady Grove Rd, Mechanicsville, Virginia |
| Authorized Official Name and Position | Jeri Dickinson Lewis (DIRECTOR) |
| Authorized Official Contact | 8043988401 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Old Towne Counseling Services, Llc 4197 Rockhill Rd Mechanicsville VA 23111-6903 Ph: (804) 398-8401 | Old Towne Counseling Services, Llc 7293 Shady Grove Rd Mechanicsville VA 23111-2129 Ph: (804) 398-8401 |
| NPI Number | 1487855003 |
|---|---|
| Provider Enumeration Date | 05/30/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 7618149865 |
|---|---|
| Medicare Enrollment ID | O20111011000695 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487855003 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 0701002806 (Virginia) | Primary |
| Provider Name | Mary E Baker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114183134 PECOS PAC ID: 3779634076 Enrollment ID: I20090626000299 |
| Provider Name | Patricia Marie Wilkinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316097884 PECOS PAC ID: 2769535327 Enrollment ID: I20090729000344 |
| Provider Name | William Butler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265517486 PECOS PAC ID: 5799941431 Enrollment ID: I20120724000522 |
| Provider Name | Mary O Butler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578582896 PECOS PAC ID: 7810129756 Enrollment ID: I20140408002094 |
| Provider Name | Lauren Goldberg Roseman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841437415 PECOS PAC ID: 3274850763 Enrollment ID: I20150320001757 |
| Provider Name | Sheri A Phuong |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588076111 PECOS PAC ID: 6507176328 Enrollment ID: I20151106001830 |
| Provider Name | Edward D Bieda |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538234877 PECOS PAC ID: 6709016652 Enrollment ID: I20181219003273 |
| Provider Name | Michelle Sams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619402096 PECOS PAC ID: 7618215641 Enrollment ID: I20190215002187 |
| Provider Name | Diana Boutte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538645015 PECOS PAC ID: 6709125651 Enrollment ID: I20190312000069 |
| Provider Name | Yasaman Aghaeinejad |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679107346 PECOS PAC ID: 2062835341 Enrollment ID: I20200702002191 |
| Provider Name | Eliza Adhikari |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962011346 PECOS PAC ID: 7416369525 Enrollment ID: I20201215000832 |
| Provider Name | Katherine Jamison Fordham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952978876 PECOS PAC ID: 4880099084 Enrollment ID: I20210826001430 |
| Provider Name | Kathryn E Coats |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871068890 PECOS PAC ID: 6901144336 Enrollment ID: I20210915004022 |
| Provider Name | Carla Doan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851065890 PECOS PAC ID: 8426446857 Enrollment ID: I20211103002747 |
| Provider Name | Peter Walker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841869823 PECOS PAC ID: 6800283193 Enrollment ID: I20220505001871 |
| Provider Name | Natalie Clements Mesco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023762531 PECOS PAC ID: 7911385232 Enrollment ID: I20220527000632 |
| Provider Name | Terica Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760898803 PECOS PAC ID: 9335519446 Enrollment ID: I20230106000899 |
| Provider Name | Zara Walker Logan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922797984 PECOS PAC ID: 3577920156 Enrollment ID: I20230613002812 |
| Provider Name | Jean Winne |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811269475 PECOS PAC ID: 1557344835 Enrollment ID: I20230614003872 |
| Provider Name | Audrey Hajek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174251961 PECOS PAC ID: 9133576036 Enrollment ID: I20231115000817 |
| Provider Name | Jamie Squires |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215619200 PECOS PAC ID: 6608227327 Enrollment ID: I20240108000828 |
| Provider Name | Morgan Hoy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114503224 PECOS PAC ID: 6204288129 Enrollment ID: I20240116004387 |
| Provider Name | Susann-nicole Schwarz |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871895284 PECOS PAC ID: 0840634994 Enrollment ID: I20240216003411 |
| Provider Name | Sarah Story |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275318586 PECOS PAC ID: 7719323922 Enrollment ID: I20240311002053 |
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