| Sea Change Counseling Llc | |
|
110 Sanchez Ave Edgewater FL 32132-1638 | |
| (386) 481-4782 | |
| Not Available |
| Full Name | Sea Change Counseling Llc |
|---|---|
| Speciality | Social Worker |
| Location | 110 Sanchez Ave, Edgewater, Florida |
| Authorized Official Name and Position | Trisha Peterson (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 3864814782 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sea Change Counseling Llc 110 Sanchez Ave Edgewater FL 32132-1638 Ph: (386) 481-4782 | Sea Change Counseling Llc 110 Sanchez Ave Edgewater FL 32132-1638 Ph: (386) 481-4782 |
| NPI Number | 1144920711 |
|---|---|
| Provider Enumeration Date | 03/03/2023 |
| Last Update Date | 03/03/2023 |
| Certification Date | 03/03/2023 |
| Medicare PECOS PAC ID | 5294198297 |
|---|---|
| Medicare Enrollment ID | O20230823003744 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144920711 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Trisha S Peterson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023561883 PECOS PAC ID: 0840668679 Enrollment ID: I20221128002904 |
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