| Centerstone Of Tennesse Inc. | |
|
7011 A C Skinner Pkwy Jacksonville FL 32256-6954 | |
| (904) 431-3500 | |
| (904) 431-3501 |
| Full Name | Centerstone Of Tennesse Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 7011 A C Skinner Pkwy, Jacksonville, Florida |
| Authorized Official Name and Position | Karen Lynette Keene (SECURITY OFFICER, IT TECHNOLOGY SUP) |
| Authorized Official Contact | 6154636523 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centerstone Of Tennesse Inc. Po Box 197520 Nashville TN 37219-7520 Ph: (615) 463-6669 | Centerstone Of Tennesse Inc. 7011 A C Skinner Pkwy Jacksonville FL 32256-6954 Ph: (904) 431-3500 |
| NPI Number | 1144836982 |
|---|---|
| Provider Enumeration Date | 09/17/2020 |
| Last Update Date | 09/17/2020 |
| Certification Date | 09/17/2020 |
| Medicare PECOS PAC ID | 9739088113 |
|---|---|
| Medicare Enrollment ID | O20210304000841 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144836982 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Nicole M Wells-cimmino |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013269133 PECOS PAC ID: 9830505577 Enrollment ID: I20210304001225 |
| Provider Name | Natalie Janine Byram |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841897287 PECOS PAC ID: 1951772607 Enrollment ID: I20230117002679 |
| Provider Name | Alexandra Katherine Field |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730525247 PECOS PAC ID: 7012375918 Enrollment ID: I20230626001712 |
| Provider Name | Deanna Marie Iovino |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265988604 PECOS PAC ID: 4284092065 Enrollment ID: I20230627001291 |
| Provider Name | Princes Mccarther |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265058952 PECOS PAC ID: 1153780739 Enrollment ID: I20230629001275 |
| Provider Name | Zoe Panizzi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255769220 PECOS PAC ID: 1759519705 Enrollment ID: I20230811001027 |
| Provider Name | Kelly M Capel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437780616 PECOS PAC ID: 5092167536 Enrollment ID: I20240119001862 |
| Provider Name | Jodie L Bielman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114454527 PECOS PAC ID: 9133571474 Enrollment ID: I20240123000380 |
| Provider Name | Ashley Carter |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1598162059 PECOS PAC ID: 6002268430 Enrollment ID: I20240227004601 |
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