| Spectrum Transformation Group, Llc | |
|
221 Stonebridge Plaza Ave Ste C North Chesterfield VA 23225-6972 | |
| (804) 378-6141 | |
| Not Available |
| Full Name | Spectrum Transformation Group, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 221 Stonebridge Plaza Ave Ste C, North Chesterfield, Virginia |
| Authorized Official Name and Position | Cedric Moore (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8043174307 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spectrum Transformation Group, Llc 221 Stonebridge Plaza Ave Ste C North Chesterfield VA 23225-6972 Ph: (804) 378-6141 | Spectrum Transformation Group, Llc 221 Stonebridge Plaza Ave Ste C North Chesterfield VA 23225-6972 Ph: (804) 378-6141 |
| NPI Number | 1174855985 |
|---|---|
| Provider Enumeration Date | 02/03/2010 |
| Last Update Date | 11/17/2020 |
| Certification Date | 11/17/2020 |
| Medicare PECOS PAC ID | 8527253830 |
|---|---|
| Medicare Enrollment ID | O20101122000475 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174855985 | NPI | - | NPPES |
| Provider Name | John C Lee |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104813427 PECOS PAC ID: 3476549247 Enrollment ID: I20040426000609 |
| Provider Name | Linda C Baxter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467489021 PECOS PAC ID: 7416028691 Enrollment ID: I20080616000359 |
| Provider Name | Jenee Lewis-walker |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457680217 PECOS PAC ID: 4880871672 Enrollment ID: I20110603000152 |
| Provider Name | Barbara B Laird |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518397959 PECOS PAC ID: 4789900895 Enrollment ID: I20150309001803 |
| Provider Name | Amber Tate |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043763410 PECOS PAC ID: 9638450927 Enrollment ID: I20161228000947 |
| Provider Name | Gloria M Kim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366956278 PECOS PAC ID: 4284996471 Enrollment ID: I20180328001904 |
| Provider Name | Melinda Beth Moore |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174771737 PECOS PAC ID: 4284782699 Enrollment ID: I20191205000509 |
| Provider Name | Nicholas A Donati |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1851597199 PECOS PAC ID: 8022449339 Enrollment ID: I20200520001255 |
| Provider Name | Michelle M Schmitt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1104453026 PECOS PAC ID: 9133545346 Enrollment ID: I20200819000706 |
| Provider Name | Courtney Hannon Kumar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497372734 PECOS PAC ID: 8921427972 Enrollment ID: I20200924003048 |
| Provider Name | Grace Fronczak |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1831755636 PECOS PAC ID: 6204202336 Enrollment ID: I20221014001307 |
| Provider Name | Sherilyn Smith |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1871091231 PECOS PAC ID: 2769858166 Enrollment ID: I20221025003314 |
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