| Dynamic Self Recovery | |
|
1010 11th Ave Sw Albany OR 97321-2019 | |
| (541) 829-1199 | |
| (833) 770-4969 |
| Full Name | Dynamic Self Recovery |
|---|---|
| Speciality | Clinic/Center |
| Location | 1010 11th Ave Sw, Albany, Oregon |
| Authorized Official Name and Position | Carol Ann Mccollum (SUPERVISOR) |
| Authorized Official Contact | 5416212698 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dynamic Self Recovery 1010 11th Ave Sw Albany OR 97321-2019 Ph: (541) 791-7193 | Dynamic Self Recovery 1010 11th Ave Sw Albany OR 97321-2019 Ph: (541) 829-1199 |
| NPI Number | 1083205298 |
|---|---|
| Provider Enumeration Date | 01/30/2021 |
| Last Update Date | 01/05/2024 |
| Certification Date | 12/28/2023 |
| Medicare PECOS PAC ID | 6608226105 |
|---|---|
| Medicare Enrollment ID | O20231226000854 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083205298 | NPI | - | NPPES |
| 500722423 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Sarah J Soric |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093176208 PECOS PAC ID: 4789011917 Enrollment ID: I20200227000786 |
| Provider Name | Sonya F James |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386318863 PECOS PAC ID: 4284004144 Enrollment ID: I20230110002749 |
| Provider Name | Sarah M Pruitt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437610565 PECOS PAC ID: 3779958509 Enrollment ID: I20230410002067 |
| Provider Name | Jaclyn Salcido Giles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790145928 PECOS PAC ID: 1052786720 Enrollment ID: I20230411001565 |
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