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501 Village Ave Ste 204 Yorktown VA 23693-5657 | |
| (757) 813-7894 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 501 Village Ave Ste 204, Yorktown, Virginia |
| Authorized Official Name and Position | Denise W Wash (OWNER) |
| Authorized Official Contact | 7578137894 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
402 Old Landing Rd Yorktown VA 23692-4316 Ph: (757) 813-7894 | 501 Village Ave Ste 204 Yorktown VA 23693-5657 Ph: (757) 813-7894 |
| NPI Number | 1255026746 |
|---|---|
| Provider Enumeration Date | 04/10/2023 |
| Last Update Date | 04/29/2024 |
| Certification Date | 04/29/2024 |
| Medicare PECOS PAC ID | 5294277075 |
|---|---|
| Medicare Enrollment ID | O20240607001940 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255026746 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | James Chrisman Loomis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609016179 PECOS PAC ID: 6002250008 Enrollment ID: I20240219000100 |
| Provider Name | Christine L Hennigan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124572375 PECOS PAC ID: 8820530603 Enrollment ID: I20240607002197 |
| Provider Name | Heather A Nickerson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275809170 PECOS PAC ID: 7719419993 Enrollment ID: I20241011003798 |
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