| Sankofa Family Counseling Services, Lcsw P.l.l.c. | |
|
1400 Portland Ave Ste 54 Rochester NY 14621-3014 | |
| (585) 491-6646 | |
| (585) 363-5822 |
| Full Name | Sankofa Family Counseling Services, Lcsw P.l.l.c. |
|---|---|
| Speciality | Social Worker |
| Location | 1400 Portland Ave Ste 54, Rochester, New York |
| Authorized Official Name and Position | Khadijah Ella Tillman (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 5857132071 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sankofa Family Counseling Services, Lcsw P.l.l.c. 1400 Portland Ave Ste 54 Rochester NY 14621-3014 Ph: (585) 491-6646 | Sankofa Family Counseling Services, Lcsw P.l.l.c. 1400 Portland Ave Ste 54 Rochester NY 14621-3014 Ph: (585) 491-6646 |
| NPI Number | 1861047292 |
|---|---|
| Provider Enumeration Date | 08/02/2019 |
| Last Update Date | 08/02/2019 |
| Medicare PECOS PAC ID | 3072986934 |
|---|---|
| Medicare Enrollment ID | O20230224001139 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861047292 | NPI | - | NPPES |
| Provider Name | Khadijah E Tillman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851618391 PECOS PAC ID: 0648495994 Enrollment ID: I20140701000562 |
| Provider Name | Latrina D Ashton Harrell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730644006 PECOS PAC ID: 1759754625 Enrollment ID: I20230224001380 |
| Provider Name | Chrisandra L Mareus |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407217730 PECOS PAC ID: 9931573490 Enrollment ID: I20230323001955 |
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