| Whitesell And Associates, Inc | |
|
900 S Main St Bldg A Suite 105 Bel Air MD 21014-5447 | |
| (410) 914-4012 | |
| (443) 817-0808 |
| Full Name | Whitesell And Associates, Inc |
|---|---|
| Speciality | Counselor |
| Location | 900 S Main St Bldg A, Bel Air, Maryland |
| Authorized Official Name and Position | Lisa Early (CLINICAL DIRECTOR) |
| Authorized Official Contact | 4109144012 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Whitesell And Associates, Inc 900a South Main Street Suite 105 Bel Air MD 21014 Ph: (410) 914-4012 | Whitesell And Associates, Inc 900 S Main St Bldg A Suite 105 Bel Air MD 21014-5447 Ph: (410) 914-4012 |
| NPI Number | 1407194905 |
|---|---|
| Provider Enumeration Date | 01/18/2013 |
| Last Update Date | 03/14/2023 |
| Certification Date | 03/14/2023 |
| Medicare PECOS PAC ID | 4385911247 |
|---|---|
| Medicare Enrollment ID | O20170524001202 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407194905 | NPI | - | NPPES |
| 0167800 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | LC0793 (Maryland) | Primary |
| Provider Name | Christina M Jensema |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1215050661 PECOS PAC ID: 4789717471 Enrollment ID: I20100802000580 |
| Provider Name | Anastasia Hope Teng |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518336171 PECOS PAC ID: 0143530709 Enrollment ID: I20170616000101 |
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