| Brambleton Assessment And Counseling Center | |
|
3536 Brambleton Avenue, Sw Suite 3 Roanoke VA 24018 | |
| (540) 580-0975 | |
| (540) 777-5453 |
| Full Name | Brambleton Assessment And Counseling Center |
|---|---|
| Speciality | Social Worker |
| Location | 3536 Brambleton Avenue, Sw, Roanoke, Virginia |
| Authorized Official Name and Position | Stephanie Ann Goodbar (OWNER) |
| Authorized Official Contact | 5407777060 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brambleton Assessment And Counseling Center 3536 Brambleton Ave Ste 3 Roanoke VA 24018-6500 Ph: (540) 777-7060 | Brambleton Assessment And Counseling Center 3536 Brambleton Avenue, Sw Suite 3 Roanoke VA 24018 Ph: (540) 580-0975 |
| NPI Number | 1194142836 |
|---|---|
| Provider Enumeration Date | 03/19/2014 |
| Last Update Date | 04/18/2018 |
| Medicare PECOS PAC ID | 5597028514 |
|---|---|
| Medicare Enrollment ID | O20180404001466 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194142836 | NPI | - | NPPES |
| 8916641 | Medicaid | VA | |
| 396724 | Other | VA | ANTHEM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 0904001648 (Virginia) | Primary |
| Provider Name | Mary Mowbray Flanary |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144597717 PECOS PAC ID: 6608170493 Enrollment ID: I20160216000397 |
| Provider Name | Stephanie Ann Goodbar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730672239 PECOS PAC ID: 8921361957 Enrollment ID: I20180814002035 |
| Provider Name | Wayne O Powell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114327699 PECOS PAC ID: 6800239641 Enrollment ID: I20240208000845 |
| Provider Name | Camilla Murnane-johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326882077 PECOS PAC ID: 1557882990 Enrollment ID: I20250303000443 |
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