| Perryville Counseling Group Pllc | |
|
3019 N Perryville Rd Rockford IL 61114-8016 | |
| (815) 975-3330 | |
| (779) 423-1761 |
| Full Name | Perryville Counseling Group Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 3019 N Perryville Rd, Rockford, Illinois |
| Authorized Official Name and Position | Martrice D Henderson-aldridge (OWNER) |
| Authorized Official Contact | 8159753330 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Perryville Counseling Group Pllc 3019 N Perryville Rd Rockford IL 61114-8016 Ph: (815) 975-3330 | Perryville Counseling Group Pllc 3019 N Perryville Rd Rockford IL 61114-8016 Ph: (815) 975-3330 |
| NPI Number | 1184450454 |
|---|---|
| Provider Enumeration Date | 09/12/2024 |
| Last Update Date | 09/12/2024 |
| Certification Date | 09/12/2024 |
| Medicare PECOS PAC ID | 7911439526 |
|---|---|
| Medicare Enrollment ID | O20241021000415 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184450454 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Matrice Denise Henderson-aldridge |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871668418 PECOS PAC ID: 5294825188 Enrollment ID: I20111228000742 |
| Provider Name | Tiffany Marchell Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508342866 PECOS PAC ID: 1456683267 Enrollment ID: I20191029000485 |
| Provider Name | Maria Juanita Green |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619684883 PECOS PAC ID: 3274068440 Enrollment ID: I20241125001990 |
| Provider Name | Rosina Joy Goodloe |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073135232 PECOS PAC ID: 8820524242 Enrollment ID: I20241209003884 |
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