| Southside Behavioral Health | |
|
143 Industrial Parkway Clarksville VA 23927 | |
| (434) 572-6916 | |
| (434) 374-3321 |
| Full Name | Southside Behavioral Health |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 143 Industrial Parkway, Clarksville, Virginia |
| Authorized Official Name and Position | Elizabeth C Engelhorn (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4345726916 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Behavioral Health Po Box 1478 143 Industrial Parkway Clarksville VA 23927 Ph: (434) 572-6916 | Southside Behavioral Health 143 Industrial Parkway Clarksville VA 23927 Ph: (434) 572-6916 |
| NPI Number | 1700890761 |
|---|---|
| Provider Enumeration Date | 07/27/2006 |
| Last Update Date | 03/09/2021 |
| Certification Date | 03/09/2021 |
| Medicare PECOS PAC ID | 4284660507 |
|---|---|
| Medicare Enrollment ID | O20050708000612 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700890761 | NPI | - | NPPES |
| 004945514 | Medicaid | VA | |
| 1912252958 | Medicaid | VA | |
| 1700890761 | Medicaid | VA | |
| CC3355 | Other | VA | MEDICARE RAILROAD |
| Provider Name | Stella Ekaette Bassey |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821070475 PECOS PAC ID: 8123000387 Enrollment ID: I20040602001226 |
| Provider Name | Tessie S Sadler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184792384 PECOS PAC ID: 2466488788 Enrollment ID: I20050708000619 |
| Provider Name | Duc K Trieu |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1659317576 PECOS PAC ID: 7012911845 Enrollment ID: I20060908000189 |
| Provider Name | Sharon Craft |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760693089 PECOS PAC ID: 3779621370 Enrollment ID: I20091118000407 |
| Provider Name | Mark W Anderegg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568499796 PECOS PAC ID: 3577688449 Enrollment ID: I20100915000809 |
| Provider Name | Cheri L Kindler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578562880 PECOS PAC ID: 4385833078 Enrollment ID: I20110111000901 |
| Provider Name | Thomas Milam |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669457677 PECOS PAC ID: 5294727889 Enrollment ID: I20110119001010 |
| Provider Name | Lauren Pate Lehmann |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447213210 PECOS PAC ID: 4880874742 Enrollment ID: I20110209000698 |
| Provider Name | Geeta V Nathan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619171600 PECOS PAC ID: 3870741176 Enrollment ID: I20120911000649 |
| Provider Name | Noman Shamim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134387699 PECOS PAC ID: 5193963700 Enrollment ID: I20130521000118 |
| Provider Name | Riaz Uddin Riaz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427011295 PECOS PAC ID: 6800899899 Enrollment ID: I20150331002901 |
| Provider Name | Joseph Waheb Iskandar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215252143 PECOS PAC ID: 1557505823 Enrollment ID: I20150403000655 |
| Provider Name | Susan G Larson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386735256 PECOS PAC ID: 4486956828 Enrollment ID: I20151231001302 |
| Provider Name | Michael Benjamin Mefford |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366708992 PECOS PAC ID: 3274798012 Enrollment ID: I20160315001263 |
| Provider Name | Thaddeus M Garland |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336447697 PECOS PAC ID: 8022287903 Enrollment ID: I20170131001378 |
| Provider Name | Gregory G Braund |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811011349 PECOS PAC ID: 8325013261 Enrollment ID: I20170816000357 |
| Provider Name | Matthew D Mceachern |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275899833 PECOS PAC ID: 3476781253 Enrollment ID: I20171002003326 |
| Provider Name | Christopher C Wall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588847917 PECOS PAC ID: 0244497873 Enrollment ID: I20171025002547 |
| Provider Name | Ann P Morris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053830745 PECOS PAC ID: 6709143167 Enrollment ID: I20171121000175 |
| Provider Name | Thayanne Delima-tokarz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619233657 PECOS PAC ID: 9830497007 Enrollment ID: I20180719003314 |
| Provider Name | Heather Amber Shlosser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417130113 PECOS PAC ID: 3678653375 Enrollment ID: I20180907002610 |
| Provider Name | Dorothy Deette Burke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497883169 PECOS PAC ID: 4587757042 Enrollment ID: I20181005000729 |
| Provider Name | Beautine Benbow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508269119 PECOS PAC ID: 4486992732 Enrollment ID: I20190212000060 |
| Provider Name | Emily Diane Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619481843 PECOS PAC ID: 1658611926 Enrollment ID: I20190322001980 |
| Provider Name | Sabrina Julianne Watkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598174633 PECOS PAC ID: 7012138209 Enrollment ID: I20190410003184 |
| Provider Name | Angelique Caley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588932149 PECOS PAC ID: 7618106394 Enrollment ID: I20190807002787 |
| Provider Name | Megan Zamora |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992354476 PECOS PAC ID: 0749613982 Enrollment ID: I20191203000140 |
| Provider Name | Yvonne Levette Cooper |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669779526 PECOS PAC ID: 1355626664 Enrollment ID: I20200108002422 |
| Provider Name | Alisha Michelle Waldron |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760030902 PECOS PAC ID: 8729409107 Enrollment ID: I20200611001080 |
| Provider Name | Anthony John Gage |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124200498 PECOS PAC ID: 1658781760 Enrollment ID: I20201030001744 |
| Provider Name | David M Hanrahan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033347125 PECOS PAC ID: 2163835398 Enrollment ID: I20210108000173 |
| Provider Name | Mary Fahrmeier |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245252303 PECOS PAC ID: 4880657527 Enrollment ID: I20210108000257 |
| Provider Name | Jamie Lorraine Evans |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962664789 PECOS PAC ID: 6901044379 Enrollment ID: I20210108001387 |
| Provider Name | Mark Alter |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730263617 PECOS PAC ID: 5991855330 Enrollment ID: I20210202000728 |
| Provider Name | Robert Kirchoff |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427312388 PECOS PAC ID: 3870739592 Enrollment ID: I20210630004271 |
| Provider Name | Pamela Hines |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477101582 PECOS PAC ID: 6406252907 Enrollment ID: I20210908004161 |
| Provider Name | Bruno Perossa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346657889 PECOS PAC ID: 5092934513 Enrollment ID: I20211130001104 |
| Provider Name | Ashley Simmons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013682822 PECOS PAC ID: 8123410768 Enrollment ID: I20220111002889 |
| Provider Name | Amanda L Thenor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609223783 PECOS PAC ID: 8224425426 Enrollment ID: I20220418000996 |
| Provider Name | Joe Darnell Trickey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821745670 PECOS PAC ID: 7719374784 Enrollment ID: I20220420002722 |
| Provider Name | Debra L Ford |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376618033 PECOS PAC ID: 1658367040 Enrollment ID: I20220611000274 |
| Provider Name | Endra Sookoor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386933158 PECOS PAC ID: 3577868934 Enrollment ID: I20220622003314 |
| Provider Name | Karen Severson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689787426 PECOS PAC ID: 0840364030 Enrollment ID: I20220628003804 |
| Provider Name | Alice Mckinzie |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720025075 PECOS PAC ID: 7012261167 Enrollment ID: I20221102001453 |
| Provider Name | Hollie Miles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760936918 PECOS PAC ID: 8527430842 Enrollment ID: I20230215001605 |
| Provider Name | Max H Goulas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609379916 PECOS PAC ID: 4284098336 Enrollment ID: I20230908000377 |
| Provider Name | Laura Frauenpreis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598456055 PECOS PAC ID: 1052775921 Enrollment ID: I20230911002422 |
| Provider Name | Thomas Lane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366961369 PECOS PAC ID: 4183088065 Enrollment ID: I20230911002743 |
| Provider Name | Lisa Mcclure |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124715396 PECOS PAC ID: 5991169583 Enrollment ID: I20230915000124 |
| Provider Name | Colleen M Mcguire |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376718403 PECOS PAC ID: 2567635626 Enrollment ID: I20230926001017 |
| Provider Name | Saurabh Kashyap |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275068702 PECOS PAC ID: 3678975141 Enrollment ID: I20231017001906 |
| Provider Name | Ksenia S Pillai |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336657725 PECOS PAC ID: 0244575470 Enrollment ID: I20231106000583 |
| Provider Name | Shivam Dubey |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073764577 PECOS PAC ID: 8325298755 Enrollment ID: I20231113000098 |
| Provider Name | Hani Nazha |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952501249 PECOS PAC ID: 0244486470 Enrollment ID: I20231117002097 |
| Provider Name | Andres Barkil-oteo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144467788 PECOS PAC ID: 9739338013 Enrollment ID: I20231128002130 |
| Provider Name | Laura J Cordonnier |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992266993 PECOS PAC ID: 1658727482 Enrollment ID: I20231128002764 |
| Provider Name | Maanasa Bandla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063972404 PECOS PAC ID: 7618203035 Enrollment ID: I20231205000111 |
| Provider Name | Wanda C Brock |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912112699 PECOS PAC ID: 8325497548 Enrollment ID: I20231213003553 |
| Provider Name | Johanna Torres-santiago |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659710721 PECOS PAC ID: 6204101744 Enrollment ID: I20231219000457 |
| Provider Name | Elizabeth C Engelhorn |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285838102 PECOS PAC ID: 0446516132 Enrollment ID: I20231221003040 |
| Provider Name | Michael Rose |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033831680 PECOS PAC ID: 8820448160 Enrollment ID: I20231228001489 |
| Provider Name | Ruth Ann Ott |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831335546 PECOS PAC ID: 0042660300 Enrollment ID: I20231228002159 |
| Provider Name | Rami Abukamil |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346685286 PECOS PAC ID: 9335440577 Enrollment ID: I20240102001314 |
| Provider Name | Darrin C Adams |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740983295 PECOS PAC ID: 8123470168 Enrollment ID: I20240116001496 |
| Provider Name | Andrew T. Power |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285326298 PECOS PAC ID: 2860844669 Enrollment ID: I20240117002786 |
| Provider Name | Ogugua Anene Maidoh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609212000 PECOS PAC ID: 3173881067 Enrollment ID: I20240122002198 |
| Provider Name | Matthew D Carpinello |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790059194 PECOS PAC ID: 2466888904 Enrollment ID: I20240130000097 |
| Provider Name | Keith Poche |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518025956 PECOS PAC ID: 4880987148 Enrollment ID: I20240206002795 |
| Provider Name | Rita K Lynch |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023286200 PECOS PAC ID: 0941643092 Enrollment ID: I20240206003092 |
| Provider Name | Makayla E Bing |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699490409 PECOS PAC ID: 1355784315 Enrollment ID: I20240206003718 |
| Provider Name | Kimberly Hatchett |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285129072 PECOS PAC ID: 3072958230 Enrollment ID: I20240227002638 |
| Provider Name | John Young |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649244773 PECOS PAC ID: 8426080573 Enrollment ID: I20240303000033 |
| Provider Name | Madeline Renals |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487217550 PECOS PAC ID: 4880924737 Enrollment ID: I20240321000990 |
| Provider Name | Adriana Foster |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467562942 PECOS PAC ID: 4981650967 Enrollment ID: I20240325003439 |
| Provider Name | Paula L Stone |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376843920 PECOS PAC ID: 6901245265 Enrollment ID: I20240418003735 |
| Provider Name | Dana B Harbison |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659477891 PECOS PAC ID: 8325013394 Enrollment ID: I20240502002594 |
| Provider Name | Lonye White |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770739583 PECOS PAC ID: 5395189799 Enrollment ID: I20240508002720 |
Clarksville Counseling Center, Plc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 403 Virginia Avenue, Suite F, Clarksville, VA 23927 Phone: 434-374-3222 Fax: 434-374-3223 | |
Family Preservation Services, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1696 Noblin Farm Rd, Clarksville, VA 23927 Phone: 434-392-3328 Fax: 434-392-3235 |