South Central Counseling Group
Organization Active NPI Clinical Social Worker · Dillwyn, VA
NPI 1619255601 · NPPES record last updated Jul 26, 2011
Key facts
- NPI
- 1619255601
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 0904006760 (VA)
- Legal business name
- SOUTH CENTRAL COUNSELING GROUP
- Practice address
- 1046 Main Street
Dillwyn, VA 23936 - Phone
- (434) 808-0604
- Fax
- (434) 808-0716
- NPI assigned
- Jul 26, 2011
- Organization subpart
- No
Authorized official
- Name
- Staci L Vinson, LCSW
- Title
- Director
- Phone
- (804) 683-5306
Practitioners 4
-
Anne Hwang Blair, LCSW
-
Staci Lynn Vinson, LCSW
-
Aimee Dumaresq, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120125000117 | VA | Part B Supplier - Clinic/Group Practice | 1052588563 |
Receives reassigned benefits from 2 practitioners Practice locations: Dillwyn, VA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | 0904006760 | VA | Yes |
Addresses
Primary practice location
1046 Main Street
Dillwyn, VA 23936
Mailing address
977 Devon Spring CT
Charlottesville, VA 22903-7833
Phone (804) 683-5306
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093004871 | Medicaid | VA |
Other providers in Dillwyn, VA
- Annie Lee Ramsay
- Theresa Anne Rupp
- Walter Edward Saxon Jr.
- Joseph S. Seiler
- Kathleen B. Seiler
- Roger Spivey
- The Discovery School of Virginia, Inc.
- Troublesome Creek Medicine
- Walter E Saxon Jr DDS PC
- Cynthia Marie Watson
All providers in Dillwyn, VA · Clinical Social Worker in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 26, 2011. 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.