Orinoco Wellness, LC
Organization Active NPI Mental Health Counselor · Graham, NC
NPI 1508577321 · NPPES record last updated Jul 31, 2023
Key facts
- NPI
- 1508577321
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Legal business name
- ORINOCO WELLNESS, LC
- Practice address
- 200 N Main St
Graham, NC 27253-2853 - Phone
- (336) 265-6595
- NPI assigned
- Dec 13, 2022
- Organization subpart
- No
Authorized official
- Name
- Steven J Barnes
- Title
- President
- Phone
- (336) 265-6723
Practitioners 5
-
Peter A. Bertelli, MSN, APRN, PMHNP-BC
-
Jailyn Jackson, LCMHC-A
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240214000808 | NC | Part B Supplier - Clinic/Group Practice | 0648614099 |
Receives reassigned benefits from 4 practitioners Practice locations: Graham, NC |
National Provider Directory
Locations
200 N Main St
Ste 304
Graham, NC 27253
Phone (336) 265-6723
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | Yes | ||
| Professional Counselor |
101YP2500X | |||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Adult Mental Health Clinic/Center | 261QM0850X | |||
| Adolescent and Children Mental Health Clinic/Center | 261QM0855X |
Addresses
Primary practice location
200 N Main St
Graham, NC 27253-2853
Mailing address
624 Bonaventure Dr Unit 302
Myrtle Beach, SC 29577-9509
Phone (336) 613-7480
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PG1298 | Medicaid | SC |
Other providers in Graham, NC
- Tara Washington Oliver
- Omni Visions, Inc.
- One More Chance Youth
- Opportunities in Abundance
- Kasey Sharp Oquinn
- Paradigm Homecare Inc
- Paradigm Homecare Inc
- Patel & Associates 1 PLLC
- Jimiskumar Satishkumar Patel
- Peak Resources of Alamance
All providers in Graham, NC · Mental Health Counselor in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2023. 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.