| Southwest Regional Counseling Service Inc | |
|
1114 E Main St Ste 4 Lebanon VA 24266-5014 | |
| (276) 883-5050 | |
| (276) 883-5998 |
| Full Name | Southwest Regional Counseling Service Inc |
|---|---|
| Speciality | Counselor |
| Location | 1114 E Main St Ste 4, Lebanon, Virginia |
| Authorized Official Name and Position | Joshua Lipford (MANAGER) |
| Authorized Official Contact | 4238958266 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Regional Counseling Service Inc Po Box 306 Lebanon VA 24266-0306 Ph: (273) 883-5050 | Southwest Regional Counseling Service Inc 1114 E Main St Ste 4 Lebanon VA 24266-5014 Ph: (276) 883-5050 |
| NPI Number | 1063078855 |
|---|---|
| Provider Enumeration Date | 05/16/2019 |
| Last Update Date | 05/16/2019 |
| Medicare PECOS PAC ID | 9133525967 |
|---|---|
| Medicare Enrollment ID | O20210902001563 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063078855 | NPI | - | NPPES |
| 1528039054 | Medicaid | VA | |
| 1720016389 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
| Provider Name | Pyung Jay Suh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295779148 PECOS PAC ID: 2860478922 Enrollment ID: I20040629000045 |
| Provider Name | Michael A Cockrum |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447470067 PECOS PAC ID: 4587638242 Enrollment ID: I20041020001099 |
| Provider Name | Tony E Yost |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1003858796 PECOS PAC ID: 6608789938 Enrollment ID: I20060314000591 |
| Provider Name | Andrew N Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558562850 PECOS PAC ID: 8729189881 Enrollment ID: I20070719000774 |
| Provider Name | Sasha Musick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306376108 PECOS PAC ID: 0345511010 Enrollment ID: I20170731001652 |
| Provider Name | Amy Lee Carpenter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437688116 PECOS PAC ID: 0648534636 Enrollment ID: I20180427000140 |
| Provider Name | Tina L Henderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831745611 PECOS PAC ID: 2365878865 Enrollment ID: I20200131000909 |
| Provider Name | Dan Nicolau |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992098396 PECOS PAC ID: 4082921358 Enrollment ID: I20210902001655 |
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