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6373 N Quail Hollow Rd Ste 202 Memphis TN 38120-1405 | |
| (901) 264-0464 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 6373 N Quail Hollow Rd Ste 202, Memphis, Tennessee |
| Authorized Official Name and Position | Ronak Desai (OWNER) |
| Authorized Official Contact | 9012640464 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1381 Harbor Park Dr Memphis TN 38103-9030 Ph: (901) 264-0464 | 6373 N Quail Hollow Rd Ste 202 Memphis TN 38120-1405 Ph: (901) 264-0464 |
| NPI Number | 1487372827 |
|---|---|
| Provider Enumeration Date | 08/22/2022 |
| Last Update Date | 12/22/2022 |
| Certification Date | 12/22/2022 |
| Medicare PECOS PAC ID | 2264803956 |
|---|---|
| Medicare Enrollment ID | O20230117000099 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487372827 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Paige Marcantel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659894194 PECOS PAC ID: 2062786890 Enrollment ID: I20170918003129 |
| Provider Name | Sarah Kristine Vassar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346517596 PECOS PAC ID: 1658777206 Enrollment ID: I20210907001208 |
| Provider Name | Roslyn R Postlewaite |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710336730 PECOS PAC ID: 4082068093 Enrollment ID: I20230925003436 |
| Provider Name | Tiffany J Williams |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174229983 PECOS PAC ID: 9234589912 Enrollment ID: I20231220003593 |
| Provider Name | Ashley Veronica Neal |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235894023 PECOS PAC ID: 0042660417 Enrollment ID: I20231227001911 |
| Provider Name | Allison Marie Rieman |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1992452890 PECOS PAC ID: 6901259027 Enrollment ID: I20240227001674 |
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