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4421 Emerson Ave Ste 204 Parkersburg WV 26104-1200 | |
| (304) 220-0441 | |
| (304) 220-0112 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 4421 Emerson Ave Ste 204, Parkersburg, West Virginia |
| Authorized Official Name and Position | Christina Jackson (OWNER) |
| Authorized Official Contact | 3042200041 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4421 Emerson Ave Ste 204 Parkersburg WV 26104-1200 Ph: (304) 220-0441 | 4421 Emerson Ave Ste 204 Parkersburg WV 26104-1200 Ph: (304) 220-0441 |
| NPI Number | 1164118642 |
|---|---|
| Provider Enumeration Date | 04/17/2023 |
| Last Update Date | 01/08/2025 |
| Certification Date | 12/17/2024 |
| Medicare PECOS PAC ID | 1456710003 |
|---|---|
| Medicare Enrollment ID | O20230629003732 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164118642 | NPI | - | NPPES |
| Provider Name | Erin Donofrio |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770722852 PECOS PAC ID: 0345395588 Enrollment ID: I20090911000276 |
| Provider Name | Christina Jackson |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1083825897 PECOS PAC ID: 2365801917 Enrollment ID: I20230629003790 |
| Provider Name | Nancy Creighton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568942894 PECOS PAC ID: 7113375684 Enrollment ID: I20231121002861 |
| Provider Name | Kristen M Bolian |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134469612 PECOS PAC ID: 6103261607 Enrollment ID: I20240223002385 |
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