| Radiance Wellness Group Llc | |
|
953 Market St Williamsport PA 17701-3448 | |
| (570) 601-4325 | |
| (570) 866-3141 |
| Full Name | Radiance Wellness Group Llc |
|---|---|
| Speciality | Counselor |
| Location | 953 Market St, Williamsport, Pennsylvania |
| Authorized Official Name and Position | Jamie Lynn Plocinski (OWNER) |
| Authorized Official Contact | 5706014325 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Radiance Wellness Group Llc 1341 E 3rd St Williamsport PA 17701-5409 Ph: (570) 601-4325 | Radiance Wellness Group Llc 953 Market St Williamsport PA 17701-3448 Ph: (570) 601-4325 |
| NPI Number | 1598336133 |
|---|---|
| Provider Enumeration Date | 07/06/2021 |
| Last Update Date | 11/21/2022 |
| Certification Date | 11/21/2022 |
| Medicare PECOS PAC ID | 2961895958 |
|---|---|
| Medicare Enrollment ID | O20220216000526 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598336133 | NPI | - | NPPES |
| 1034210900007 | Medicaid | PA | |
| 1038257700001 | Medicaid | PA | |
| 1037997140001 | Medicaid | PA | |
| 1039567180002 | Medicaid | PA | |
| 1034210900002 | Medicaid | PA | |
| 1038257700002 | Medicaid | PA | |
| 1039455450002 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jamie L Plocinski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982837316 PECOS PAC ID: 2668790874 Enrollment ID: I20150421000053 |
| Provider Name | Kristina R Castner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063086544 PECOS PAC ID: 8325484686 Enrollment ID: I20240308000639 |
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