| Prince William County Community Services Board | |
|
7969 Ashton Ave Manassas VA 20109-2885 | |
| (703) 792-7800 | |
| (703) 792-5699 |
| Full Name | Prince William County Community Services Board |
|---|---|
| Speciality | Clinic/Center |
| Location | 7969 Ashton Ave, Manassas, Virginia |
| Authorized Official Name and Position | Ansar Shand (MANAGER) |
| Authorized Official Contact | 7037927800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prince William County Community Services Board 7969 Ashton Ave Manassas VA 20109-2885 Ph: (703) 792-7800 | Prince William County Community Services Board 7969 Ashton Ave Manassas VA 20109-2885 Ph: (703) 792-7800 |
| NPI Number | 1053402800 |
|---|---|
| Provider Enumeration Date | 09/27/2006 |
| Last Update Date | 10/30/2013 |
| Medicare PECOS PAC ID | 7113912973 |
|---|---|
| Medicare Enrollment ID | O20040420000249 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053402800 | NPI | - | NPPES |
| 004978277 | Medicaid | VA | |
| 210245 | Other | VA | BLUE CROSS BLUE SHIELD |
| 004945247 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jill A Parker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720119886 PECOS PAC ID: 7113912411 Enrollment ID: I20040416000647 |
| Provider Name | Audrey M Rushin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689727349 PECOS PAC ID: 2062490675 Enrollment ID: I20040710000028 |
| Provider Name | Swarna Reddy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528044583 PECOS PAC ID: 5496711830 Enrollment ID: I20041207000751 |
| Provider Name | Ruby Thomas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497705032 PECOS PAC ID: 8628012986 Enrollment ID: I20050616001121 |
| Provider Name | Evelyn M Hatfield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023124526 PECOS PAC ID: 4082716410 Enrollment ID: I20070302000372 |
| Provider Name | Imran Akram |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053449389 PECOS PAC ID: 9234237124 Enrollment ID: I20070530000378 |
| Provider Name | Sumera Nadeem |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225226152 PECOS PAC ID: 6406922590 Enrollment ID: I20080915000398 |
| Provider Name | Jyoti H Supanekar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902943483 PECOS PAC ID: 0244262251 Enrollment ID: I20090317000418 |
| Provider Name | Katharine H Mchugh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841424637 PECOS PAC ID: 4981757655 Enrollment ID: I20090728000301 |
| Provider Name | Laura L Harvatine |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669407573 PECOS PAC ID: 3375546757 Enrollment ID: I20110517000798 |
| Provider Name | Claudia L Bailey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235216771 PECOS PAC ID: 3577726694 Enrollment ID: I20120529000369 |
| Provider Name | Nina Khachiyants |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376706887 PECOS PAC ID: 5395993760 Enrollment ID: I20120911000210 |
| Provider Name | Nanah Sesay |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306171145 PECOS PAC ID: 9830348630 Enrollment ID: I20121011000818 |
| Provider Name | Mohammad A Ansari |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891874863 PECOS PAC ID: 3274567300 Enrollment ID: I20121205000513 |
| Provider Name | Syed W Rizvi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396824363 PECOS PAC ID: 9931151784 Enrollment ID: I20130102000263 |
| Provider Name | Rajeev Sharma |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710309950 PECOS PAC ID: 9335367960 Enrollment ID: I20140824000007 |
| Provider Name | Merrielyn J Maldonado |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114156601 PECOS PAC ID: 3779704853 Enrollment ID: I20141015001611 |
| Provider Name | Richard Rosse |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316049570 PECOS PAC ID: 6800196965 Enrollment ID: I20151123001530 |
| Provider Name | Lenelle M Mozell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841414703 PECOS PAC ID: 2264735869 Enrollment ID: I20160114000801 |
| Provider Name | Ledro Justice |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306948526 PECOS PAC ID: 3779477526 Enrollment ID: I20160212001609 |
| Provider Name | Gagandeep Khurana |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104261858 PECOS PAC ID: 7517275233 Enrollment ID: I20160413000129 |
| Provider Name | Kanchan P Clark |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649230509 PECOS PAC ID: 0941590608 Enrollment ID: I20161017002292 |
| Provider Name | Donovan D Clark |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235199100 PECOS PAC ID: 9234429457 Enrollment ID: I20161019003190 |
| Provider Name | Sirajul Hasan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144561499 PECOS PAC ID: 5597053504 Enrollment ID: I20170316001838 |
| Provider Name | Stacey Burton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265680557 PECOS PAC ID: 7719166644 Enrollment ID: I20170329001543 |
| Provider Name | Rajinderpal Singh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548420813 PECOS PAC ID: 0547547838 Enrollment ID: I20170516001630 |
| Provider Name | Jacquelyn Marie Brannock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063942670 PECOS PAC ID: 3274809157 Enrollment ID: I20171019003142 |
| Provider Name | Tracie B Rivera |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477787026 PECOS PAC ID: 3870747132 Enrollment ID: I20171211000246 |
| Provider Name | Caitlyn Bills |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528550159 PECOS PAC ID: 4486902558 Enrollment ID: I20180806002594 |
| Provider Name | Laurence S Shindelman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073634960 PECOS PAC ID: 3375892961 Enrollment ID: I20180815000477 |
| Provider Name | Kossi Pierre Eklou |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609360635 PECOS PAC ID: 9335490432 Enrollment ID: I20181001000276 |
| Provider Name | Christabel Lartey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962762237 PECOS PAC ID: 4688928484 Enrollment ID: I20181206003255 |
| Provider Name | Sarah Ann Burns |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538640677 PECOS PAC ID: 7618216979 Enrollment ID: I20190304001490 |
| Provider Name | Allison Marquardt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326505082 PECOS PAC ID: 6406199819 Enrollment ID: I20190528000257 |
| Provider Name | Karie Lyn Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376800573 PECOS PAC ID: 8820242290 Enrollment ID: I20200303001244 |
| Provider Name | Sarah Elizabeth Lee Hickey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326587809 PECOS PAC ID: 8729416896 Enrollment ID: I20200324001453 |
| Provider Name | Diminga Ester Duke-pratt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134741614 PECOS PAC ID: 3476974007 Enrollment ID: I20200605001625 |
| Provider Name | Edward Carl Huycke |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215904826 PECOS PAC ID: 4880016732 Enrollment ID: I20200622002715 |
| Provider Name | Khalida Jahed |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801494489 PECOS PAC ID: 2466862339 Enrollment ID: I20201104000362 |
| Provider Name | Malinda Ann Abramovich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962051912 PECOS PAC ID: 3072923473 Enrollment ID: I20201112002332 |
| Provider Name | Trisha Nicole Ungar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255841078 PECOS PAC ID: 8729499314 Enrollment ID: I20201203001689 |
| Provider Name | Katherine Suzanne Hetrick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245833466 PECOS PAC ID: 4688086507 Enrollment ID: I20201218000267 |
| Provider Name | Shariff T Ruffin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487242855 PECOS PAC ID: 6800201161 Enrollment ID: I20210218000945 |
| Provider Name | Aida Bengussie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982299889 PECOS PAC ID: 5890103501 Enrollment ID: I20210419001854 |
| Provider Name | Sarah Ann Duffy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124636162 PECOS PAC ID: 1557779006 Enrollment ID: I20210421001727 |
| Provider Name | Tammy Denise Knoll |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578144291 PECOS PAC ID: 2264840404 Enrollment ID: I20210428000364 |
| Provider Name | Saroj Uprety |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558943100 PECOS PAC ID: 6103235197 Enrollment ID: I20210504000270 |
| Provider Name | Daniel Matthew Manza |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255855078 PECOS PAC ID: 6800205147 Enrollment ID: I20210517002195 |
| Provider Name | Kathryn Marie Bowler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821698192 PECOS PAC ID: 3476962739 Enrollment ID: I20210518000087 |
| Provider Name | Kathryn Thorn Weaver |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992330906 PECOS PAC ID: 5991105405 Enrollment ID: I20210621000369 |
| Provider Name | Dominique Danquah |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164005617 PECOS PAC ID: 5799188611 Enrollment ID: I20210729000424 |
| Provider Name | Minh-chau Nguyen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851321491 PECOS PAC ID: 5496774390 Enrollment ID: I20210914002869 |
| Provider Name | Kym M Ludwig |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215694807 PECOS PAC ID: 6507251212 Enrollment ID: I20220316001179 |
| Provider Name | Patty Jane Zavaleta |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821742347 PECOS PAC ID: 7214322692 Enrollment ID: I20220322000853 |
| Provider Name | Kendra M Griffin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669198321 PECOS PAC ID: 5799154803 Enrollment ID: I20221213000971 |
| Provider Name | Harry Hogshead |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508570896 PECOS PAC ID: 0941671267 Enrollment ID: I20230125000967 |
| Provider Name | Yasmeen Atyia Ayesha Burnell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205543410 PECOS PAC ID: 4082085089 Enrollment ID: I20230131001602 |
| Provider Name | Isabel Patricia Navarro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912603770 PECOS PAC ID: 7012380389 Enrollment ID: I20230307002439 |
| Provider Name | Renita Livingston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801294533 PECOS PAC ID: 8820463078 Enrollment ID: I20230331001608 |
| Provider Name | Angel Bartlett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801409123 PECOS PAC ID: 3274908330 Enrollment ID: I20230404001244 |
| Provider Name | Veronica Newman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780379883 PECOS PAC ID: 0143685941 Enrollment ID: I20230501001885 |
| Provider Name | Tomasina Rucker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073399176 PECOS PAC ID: 3678920782 Enrollment ID: I20231111000096 |
| Provider Name | Stephanie Bile Oulatta |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285290148 PECOS PAC ID: 2961850201 Enrollment ID: I20231128001896 |
| Provider Name | Samuel Woldeghebriel Seium |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1346863214 PECOS PAC ID: 0244680668 Enrollment ID: I20231228000148 |
| Provider Name | Sarah Jane Clarius |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518528884 PECOS PAC ID: 0941650238 Enrollment ID: I20231228003035 |
| Provider Name | Jessica Lorita Thomas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629424353 PECOS PAC ID: 9931559093 Enrollment ID: I20240102002042 |
| Provider Name | Vester Appiah |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1508544933 PECOS PAC ID: 3577913649 Enrollment ID: I20240102002454 |
| Provider Name | Katherine Valliere |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699030908 PECOS PAC ID: 3577913599 Enrollment ID: I20240103000579 |
| Provider Name | Olivia Adelle Sweetnam |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770105744 PECOS PAC ID: 4688025687 Enrollment ID: I20240103003773 |
| Provider Name | Sharon Elizabeth Perrine |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417666934 PECOS PAC ID: 8729439732 Enrollment ID: I20240103003959 |
| Provider Name | Christopher Harold Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831273564 PECOS PAC ID: 5890146757 Enrollment ID: I20240105000159 |
| Provider Name | Jacqueline Olivia Campa |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1710631213 PECOS PAC ID: 3375994098 Enrollment ID: I20240108000652 |
| Provider Name | Nichole Dixon Wray |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1932734993 PECOS PAC ID: 1557712056 Enrollment ID: I20240109003503 |
| Provider Name | Talifa Yvonne Bailey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568978310 PECOS PAC ID: 6608227962 Enrollment ID: I20240111000088 |
| Provider Name | Erka Mucaj |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003346941 PECOS PAC ID: 3476904616 Enrollment ID: I20240111003236 |
| Provider Name | Ann Calvert Brown |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326125832 PECOS PAC ID: 3678924818 Enrollment ID: I20240111003479 |
| Provider Name | Amanda Marie Ward |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346948767 PECOS PAC ID: 4789036732 Enrollment ID: I20240116001820 |
| Provider Name | M.claire H Dutrow |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1265516595 PECOS PAC ID: 6608228127 Enrollment ID: I20240122000017 |
| Provider Name | Nicole Lee Ann Brooks |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639889280 PECOS PAC ID: 4486006855 Enrollment ID: I20240122002080 |
| Provider Name | Marla Anne Peterson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821527102 PECOS PAC ID: 2466895610 Enrollment ID: I20240205003906 |
| Provider Name | Brittany Rouiller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730966813 PECOS PAC ID: 3173966579 Enrollment ID: I20240212004483 |
| Provider Name | Arthur Daniel Square |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1255983987 PECOS PAC ID: 5294179248 Enrollment ID: I20240216004009 |
| Provider Name | Katherine Grace Briggs |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639263817 PECOS PAC ID: 8022452960 Enrollment ID: I20240219001871 |
| Provider Name | Nadia Marie Asfahani |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922185453 PECOS PAC ID: 5294179115 Enrollment ID: I20240220000988 |
| Provider Name | Emily N Girard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639559875 PECOS PAC ID: 2163866732 Enrollment ID: I20240222001449 |
| Provider Name | Suzanne Brooks Herberg |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497839732 PECOS PAC ID: 7214371806 Enrollment ID: I20240222002005 |
| Provider Name | Brittany Lynn Anderson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1902559974 PECOS PAC ID: 4385088822 Enrollment ID: I20240222003835 |
| Provider Name | Donna Armstrong |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417404807 PECOS PAC ID: 4385089424 Enrollment ID: I20240229000055 |
| Provider Name | Lisa J Hilton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568634145 PECOS PAC ID: 6002253606 Enrollment ID: I20240319000598 |
| Provider Name | Annette Marie Thomas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447595079 PECOS PAC ID: 1052758448 Enrollment ID: I20240320004129 |
| Provider Name | Lynn M Otto |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1265983936 PECOS PAC ID: 8426495862 Enrollment ID: I20240321001499 |
| Provider Name | Angelica N Bigsby |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396338893 PECOS PAC ID: 2466899745 Enrollment ID: I20240321003524 |
| Provider Name | Jamie Christine Ward |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487372660 PECOS PAC ID: 8426495334 Enrollment ID: I20240326004471 |
| Provider Name | Irena Whitestone |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215413943 PECOS PAC ID: 7214375773 Enrollment ID: I20240402004398 |
| Provider Name | Rachel Marie Gilbert |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1346857810 PECOS PAC ID: 9436598281 Enrollment ID: I20240412003906 |
| Provider Name | Demetries L North |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548928104 PECOS PAC ID: 2466892203 Enrollment ID: I20240426003106 |
| Provider Name | Jessica Nicole Stewart |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316510217 PECOS PAC ID: 0547600090 Enrollment ID: I20240430004217 |
| Provider Name | Elizabeth Ashley Hilliard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629766688 PECOS PAC ID: 1951742725 Enrollment ID: I20240510000412 |
| Provider Name | Adevia Elvira Hellen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194575720 PECOS PAC ID: 3870934078 Enrollment ID: I20240517002055 |
| Provider Name | Elise Wade Crawford |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760599179 PECOS PAC ID: 0345782306 Enrollment ID: I20240605001509 |
New Leaf Counseling, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 8712 Sudley Rd, Manassas, VA 20110 Phone: 571-599-0312 | |
Counseling Bliss Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 9246b Mosby St, Manassas, VA 20110 Phone: 571-358-1728 | |
Talako Industries Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 8711 Plantation Ln Ste 301, Manassas, VA 20110 Phone: 703-345-0588 | |
Gpc Therapy Associates, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 9300 Forest Point Cir, Manassas, VA 20110 Phone: 703-508-4578 | |
Gateway Integrative Therapy Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 9720 Capital Ct Ste 100, Manassas, VA 20110 Phone: 703-895-6466 | |
Northern Virginia Christian Counseling Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 10620 Crestwood Dr, Manassas, VA 20109 Phone: 814-474-6454 |