| Myndworx | |
|
1144 Western Blvd # 1008 Jacksonville NC 28546-6651 | |
| (910) 543-3003 | |
| (910) 541-9488 |
| Full Name | Myndworx |
|---|---|
| Speciality | Counselor |
| Location | 1144 Western Blvd # 1008, Jacksonville, North Carolina |
| Authorized Official Name and Position | Anneke Johnson (OWNER) |
| Authorized Official Contact | 9102697456 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Myndworx 1144 Western Blvd # 1008 Jacksonville NC 28546-6651 Ph: (910) 543-3003 | Myndworx 1144 Western Blvd # 1008 Jacksonville NC 28546-6651 Ph: (910) 543-3003 |
| NPI Number | 1376121103 |
|---|---|
| Provider Enumeration Date | 04/01/2021 |
| Last Update Date | 01/22/2024 |
| Certification Date | 01/22/2024 |
| Medicare PECOS PAC ID | 8820440506 |
|---|---|
| Medicare Enrollment ID | O20240118000697 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376121103 | NPI | - | NPPES |
| 000000000000000 | Other | N/A | |
| HO1718960 | Other | HI | DRIVER LICENSE |
| Provider Name | Anneke Lane Johnson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841544947 PECOS PAC ID: 9739531419 Enrollment ID: I20240118001204 |
| Provider Name | Tamra Lee Ellsworth |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770095655 PECOS PAC ID: 7719330182 Enrollment ID: I20240201002166 |
| Provider Name | Jennifer P Clapton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609164664 PECOS PAC ID: 4789828898 Enrollment ID: I20240207003478 |
| Provider Name | Kamay H Gaboda |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326201120 PECOS PAC ID: 7012350630 Enrollment ID: I20240209002844 |
| Provider Name | John Wayne Loranger |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1508344995 PECOS PAC ID: 3971947599 Enrollment ID: I20240221004084 |
| Provider Name | Joseph E. Corbin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437408697 PECOS PAC ID: 3072957604 Enrollment ID: I20240222000008 |
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