| Safe Harbor Behavioral Care Of Northern Virginia Llc | |
|
8304 Old Keene Mill Rd Springfield VA 22152-1640 | |
| (410) 893-4600 | |
| (443) 640-4358 |
| Full Name | Safe Harbor Behavioral Care Of Northern Virginia Llc |
|---|---|
| Speciality | Counselor |
| Location | 8304 Old Keene Mill Rd, Springfield, Virginia |
| Authorized Official Name and Position | Jeffrey Crosson (REGIONAL DIRECTOR) |
| Authorized Official Contact | 4108934600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Safe Harbor Behavioral Care Of Northern Virginia Llc 8020 Greeley Blvd Springfield VA 22152-3001 Ph: () - | Safe Harbor Behavioral Care Of Northern Virginia Llc 8304 Old Keene Mill Rd Springfield VA 22152-1640 Ph: (410) 893-4600 |
| NPI Number | 1043660905 |
|---|---|
| Provider Enumeration Date | 06/21/2016 |
| Last Update Date | 09/17/2021 |
| Certification Date | 09/17/2021 |
| Medicare PECOS PAC ID | 0446531040 |
|---|---|
| Medicare Enrollment ID | O20161219001684 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043660905 | NPI | - | NPPES |
| Provider Name | Martha Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083858351 PECOS PAC ID: 7315163219 Enrollment ID: I20140730001007 |
| Provider Name | Mary Niemi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427484716 PECOS PAC ID: 5799903696 Enrollment ID: I20140905000221 |
| Provider Name | Claudia T Mcdowell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306343538 PECOS PAC ID: 6103258322 Enrollment ID: I20191108001836 |
| Provider Name | Michelle Wenz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699278085 PECOS PAC ID: 6103231139 Enrollment ID: I20210224001927 |
| Provider Name | Christen Panissidi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750907762 PECOS PAC ID: 8820471345 Enrollment ID: I20220816003901 |
| Provider Name | Catherine Kim |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255043691 PECOS PAC ID: 0345606950 Enrollment ID: I20230523002253 |
| Provider Name | Brian Rink |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700502564 PECOS PAC ID: 9032575626 Enrollment ID: I20230524002479 |
| Provider Name | Amity Kim |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548764780 PECOS PAC ID: 3678932928 Enrollment ID: I20230705000194 |
| Provider Name | Marsi Beschel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780189555 PECOS PAC ID: 3678923323 Enrollment ID: I20231221001980 |
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