Yvette Genine Pack, LCSW-C, CCM, NBC-HWC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

06830 Issued in MD

Practice address

6824 Sewells Orchard Dr
Columbia, MD 21045-4487

Phone

(443) 204-4148

NPI assigned

Dec 8, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Yvette Genine Pack Logan Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1670457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670457600000",
    "number": "1174234256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6824 SEWELLS ORCHARD DR",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210454487",
            "telephone_number": "410-381-2196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6824 SEWELLS ORCHARD DR",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210454487",
            "telephone_number": "443-204-4148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACK",
        "first_name": "YVETTE",
        "middle_name": "GENINE",
        "credential": "LCSW-C, CCM, NBC-HWC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-08",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": "702824736",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "06830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "YVETTE",
            "last_name": "PACK LOGAN",
            "middle_name": "GENINE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Tatiana Pabon
• Mary Noelle Pabst, RD
• Bonnie S Pace, MS, LDN
• Pacific Neuromonitoring Associates, Inc
• Alison Rebecca Pack, MS RD LDN
• Packer Medical Office Maintenance, LLC
• Eleanor Paczkowski
• Padder Health Services, LLC
• Padder Health Services, LLC
• Padder Health Services, LLC

• Clinical Social Worker in Columbia, MD
• Providers in Columbia, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.