Middle Peninsula Northern Neck Mental Health & Retardation
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Gloucester, VA
NPI 1497717615 · NPPES record last updated Jun 21, 2018
Key facts
- NPI
- 1497717615
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- MIDDLE PENINSULA NORTHERN NECK MENTAL HEALTH & RETARDATION
- Practice address
- 9228 George Washington Memorial Hwy
Gloucester, VA 23061-4162 - Phone
- (804) 693-5068
- Fax
- (804) 693-7407
- NPI assigned
- Apr 4, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Yvonne M Wingrove, M.ED.
- Title
- Chief Financial Officer
- Phone
- (804) 693-5640
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 5
Practitioners 87
-
Michael Barlow, LCSW
-
Wanda J Dungan, L.P.C.
-
Denise Ferguson, LPC
-
Shahana N Garner, L.C.S.W.
-
Linda D Kelly, LPC
-
Jenna M McCormick, LCSW
-
Pamela Minor, LPC
-
Antoinette Payne, LCSW
-
Winona Pearson, LCSW
-
Christina Marie Reed, LPC
-
Parthiv J Sheth, M.D.
-
Salman Siddiqui, M.D.
-
Keshawna Tiggle, LPC
-
Daeryl Williamson, PMHNP
-
Amy E Hill, LNP
-
Amanda Lynn Ashburn, LPC
-
Joanne P. Brown, LPC, LMFT
-
Anna Merrill Cameron, LCSW
-
Sabrina Gertrude Curry, LCSW
-
Kelsey Amanda Curtis, LCSW
-
Stephanie Doswell, LPC
-
Emily S Eanes, L.P.C.
-
Caitlin Gallagher, LPC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031124000358 | VA | Part B Supplier - Clinic/Group Practice | 1254235989 |
Receives reassigned benefits from 55 practitioners Practice locations: Gloucester, VA; Saluda, VA; Tappahannock, VA |
National Provider Directory
- Tax ID family
- Middle Peninsula Northern Neck Mental Health Retardation
Locations
5959 Fiddlers Green Rd
Gloucester, VA 23061
1041 Sharon Rd
Ste 201
King William, VA 23086
Phone (804) 769-2751
414 Main St
Warsaw, VA 22572
Phone (804) 333-3671
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
9228 George Washington Memorial Hwy
Gloucester, VA 23061-4162
Mailing address
PO Box 269
Ark, VA 23003-0269
Phone (804) 693-5640
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497717615 | Medicaid | VA | |
| 294721 | Other | VA | VALUE OPTIONS |
| 250204 | Other | VA | ANTHEM |
| 250208 | Other | VA | ANTHEM |
| 004945115 | Medicaid | VA | |
| 250202 | Other | VA | ANTHEM |
Other names
- MIDDLE PENINSULA NORTHERN NECK COUNSELING CENTER
Other providers in Gloucester, VA
- Medicab Services by Ew Inc
- Melvin W Ressler, MD Surgeon PC T/a Gloucester Surgery
- Layton William Merithew
- Caci Kathleen Meyers
- Middle Peninsula Northern Neck Community Services Board
- Middle Peninsula Oral and Facial Surgery LLC
- Pamela Minor
- Jozie Minter
- Mobjack Medical Group
- Joseph Morris III
All providers in Gloucester, VA · Mental Health Clinic/Center (Including Community Mental Health Center) in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2018. 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.