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430 Woodruff Rd Ste 450 Greenville SC 29607-3443 | |
| (864) 659-6670 | |
| (864) 818-4697 |
| Full Name | |
|---|---|
| Speciality | Specialist |
| Location | 430 Woodruff Rd Ste 450, Greenville, South Carolina |
| Authorized Official Name and Position | Kristin N Hall (OPERATIONS LEADER) |
| Authorized Official Contact | 8643026012 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
430 Woodruff Rd Ste 450 Greenville SC 29607-3443 Ph: (864) 659-6670 | 430 Woodruff Rd Ste 450 Greenville SC 29607-3443 Ph: (864) 659-6670 |
| NPI Number | 1457073694 |
|---|---|
| Provider Enumeration Date | 09/14/2022 |
| Last Update Date | 12/06/2024 |
| Certification Date | 12/06/2024 |
| Medicare PECOS PAC ID | 3577938224 |
|---|---|
| Medicare Enrollment ID | O20230411000910 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457073694 | NPI | - | NPPES |
| Provider Name | Deborah J Whittemore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972744795 PECOS PAC ID: 5799832036 Enrollment ID: I20150730011941 |
| Provider Name | Laura L Vail |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801452727 PECOS PAC ID: 0244561850 Enrollment ID: I20191014000978 |
| Provider Name | Cecil G Plumley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659334647 PECOS PAC ID: 5395168645 Enrollment ID: I20200706002090 |
| Provider Name | Annie Laurie Forrest |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841531373 PECOS PAC ID: 1254710155 Enrollment ID: I20220623002316 |
| Provider Name | Kayla Gail Anthony |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194196576 PECOS PAC ID: 9739531658 Enrollment ID: I20240116004438 |
| Provider Name | Daniela Marie Hatter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447735873 PECOS PAC ID: 9032561964 Enrollment ID: I20240117000011 |
| Provider Name | Rachel Elizabeth Roberts |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306439187 PECOS PAC ID: 7911345129 Enrollment ID: I20240408001812 |
| Provider Name | Chandra Shawan Mills |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295094696 PECOS PAC ID: 3072954825 Enrollment ID: I20240510003432 |
| Provider Name | Mishelle Lozano Lockerby |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093213621 PECOS PAC ID: 1153763842 Enrollment ID: I20240528000201 |
| Provider Name | Heather Ann Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598803520 PECOS PAC ID: 2163861337 Enrollment ID: I20240612000689 |
| Provider Name | Emily Halbert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629827316 PECOS PAC ID: 5193268068 Enrollment ID: I20240619002513 |
| Provider Name | Ashley Shakirie Simmons |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548999113 PECOS PAC ID: 0143766634 Enrollment ID: I20240719003242 |
| Provider Name | Katherine M Tarleton |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1629631064 PECOS PAC ID: 9335674738 Enrollment ID: I20241121003884 |
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