| Sea Glass Counseling Collaborative | |
|
1606 Harbour Dr Wilmington NC 28401-7716 | |
| (910) 399-1695 | |
| (910) 207-5335 |
| Full Name | Sea Glass Counseling Collaborative |
|---|---|
| Speciality | Counselor |
| Location | 1606 Harbour Dr, Wilmington, North Carolina |
| Authorized Official Name and Position | Tina Marie Cooke (OWNER/PRESIDENT) |
| Authorized Official Contact | 9739196698 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sea Glass Counseling Collaborative 1512b Bonito Ln Carolina Beach NC 28428-5765 Ph: (973) 919-6698 | Sea Glass Counseling Collaborative 1606 Harbour Dr Wilmington NC 28401-7716 Ph: (910) 399-1695 |
| NPI Number | 1821706946 |
|---|---|
| Provider Enumeration Date | 11/08/2022 |
| Last Update Date | 08/18/2024 |
| Certification Date | 08/18/2024 |
| Medicare PECOS PAC ID | 2961865936 |
|---|---|
| Medicare Enrollment ID | O20230824001833 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821706946 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Ambrosia Spaulding |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962777284 PECOS PAC ID: 3577869460 Enrollment ID: I20160302001056 |
| Provider Name | Jessica Paige Meyer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558075317 PECOS PAC ID: 9638532609 Enrollment ID: I20230824002095 |
| Provider Name | Tina Marie Cooke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437201399 PECOS PAC ID: 7315300381 Enrollment ID: I20231207001921 |
| Provider Name | Traci Lynn Klasing |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871644229 PECOS PAC ID: 6800245440 Enrollment ID: I20231208000440 |
| Provider Name | Debra Umhoefer Young |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1346594751 PECOS PAC ID: 8820447170 Enrollment ID: I20231212001199 |
| Provider Name | Laterriar Turner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558842831 PECOS PAC ID: 9335590314 Enrollment ID: I20240104001463 |
| Provider Name | Jill Joseph Toncer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356772800 PECOS PAC ID: 6901259266 Enrollment ID: I20240202000965 |
| Provider Name | Nicole Isabella Burley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336892165 PECOS PAC ID: 6406298470 Enrollment ID: I20240522000652 |
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