| Ppcc, Inc. | |
|
259 E Oakdale Ave Crestview FL 32539-3547 | |
| (850) 398-5255 | |
| (850) 689-8799 |
| Full Name | Ppcc, Inc. |
|---|---|
| Speciality | Counselor |
| Location | 259 E Oakdale Ave, Crestview, Florida |
| Authorized Official Name and Position | Susan M Page (PRESIDENT) |
| Authorized Official Contact | 8506821234 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ppcc, Inc. 259 E Oakdale Ave Crestview FL 32539-3547 Ph: (850) 398-5255 | Ppcc, Inc. 259 E Oakdale Ave Crestview FL 32539-3547 Ph: (850) 398-5255 |
| NPI Number | 1164747739 |
|---|---|
| Provider Enumeration Date | 04/07/2010 |
| Last Update Date | 05/21/2024 |
| Certification Date | 05/21/2024 |
| Medicare PECOS PAC ID | 3870627284 |
|---|---|
| Medicare Enrollment ID | O20100819000919 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164747739 | NPI | - | NPPES |
| Provider Name | Nina J Gawlik |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134280266 PECOS PAC ID: 6608843438 Enrollment ID: I20040913000352 |
| Provider Name | Victoria E Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245253558 PECOS PAC ID: 4688673536 Enrollment ID: I20061204000383 |
| Provider Name | Lisa Burner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750472841 PECOS PAC ID: 6204924061 Enrollment ID: I20071113000417 |
| Provider Name | Michelle L Milligan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073097440 PECOS PAC ID: 6002151958 Enrollment ID: I20181220001658 |
| Provider Name | Samantha M Ervin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659962363 PECOS PAC ID: 5294142519 Enrollment ID: I20210401001066 |
| Provider Name | Stephanie Diane Lilly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194200147 PECOS PAC ID: 3779828496 Enrollment ID: I20240506004459 |
| Provider Name | Rebecca A Bortnyik |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225357767 PECOS PAC ID: 2264974591 Enrollment ID: I20240603000625 |
| Provider Name | Susan Page |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104979863 PECOS PAC ID: 6709854029 Enrollment ID: I20240603003487 |
| Provider Name | Jody Mowrey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1144829367 PECOS PAC ID: 9739621343 Enrollment ID: I20240611003092 |
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