Eastern Shore Community MH Mr Sas Services Board
Organization Active NPI Professional Counselor · Parksley, VA
NPI 1154411510 · NPPES record last updated Nov 5, 2007
Key facts
- NPI
- 1154411510
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Professional Counselor 101YP2500X
- Legal business name
- EASTERN SHORE COMMUNITY MH MR SAS SERVICES BOARD
- Practice address
- 19056 Greenbush Rd
Parksley, VA 23421 - Phone
- (757) 665-1260
- Fax
- (757) 665-4184
- NPI assigned
- Oct 13, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. James A Cannon
- Title
- Executive Director
- Phone
- (757) 442-3636
Corporate family (same tax ID) 1
Practitioners 29
-
Stephen Paul Boersman, PSYCHIATRIC NP
-
Virginia Annette Brock, PMHNP
-
Rebecca Ellen Creed, LCSW
-
Christine D Delo, LCSW
-
Jennifer Ahn Hanner, M.D.
-
Michael Potter Henderson, M.D.
-
Susan Renee Johnson, LPC
-
Robin Marohl, LPC
-
Ellen S Miles, LPC
-
John Donald Ogram, M.D.
-
Ebony Lea'Shay Smith, LCSW
-
Diana K Stone, LPC, MS
-
Beverly Turner, LPC
-
Brent R Anderson, MD
-
Sandra Onyeagoro, M.D.
-
Johanna Cordell, LCSW
-
John Willis Konkel, LPC
-
Paige Rew McLean, LCSW
-
Alicia Nicole Rose, CNS, NP
-
Molly Walker, LCSW
-
Riaz Uddin Riaz, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070521000579 | VA | Part B Supplier - Clinic/Group Practice | 8729185095 |
Receives reassigned benefits from 26 practitioners Practice locations: Nassawadox, VA; Parksley, VA |
National Provider Directory
- Tax ID family
- Eastern Shore Behavioral Healthcare Center
Locations
19056 Greenbush Rd
Parksley, VA 23421
Phone (757) 665-1260
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | Yes |
Addresses
Primary practice location
19056 Greenbush Rd
Parksley, VA 23421
Mailing address
PO Box 453
Nassawadox, VA 23413-0453
Phone (757) 442-3636
Other names
- Eastern Shore Behavioral Healthcare Center
Other providers in Parksley, VA
- Jayne Anne Carrels-Zeller
- Derek Blaine Clark
- Mary A Clark
- Lilian Davalos
- Nidya De la Torre
- Eastern Shore Community Services Board
- Eastern Shore Rural Health System Incorporated
- Lindsay Evans
- Tian Fei
- Scott Field
All providers in Parksley, VA · Professional Counselor in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.