| Centerstone Of Tennessee, Inc. | |
|
345 W Memorial Dr Hinesville GA 31313-2413 | |
| (888) 291-4357 | |
| Not Available |
| Full Name | Centerstone Of Tennessee, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 345 W Memorial Dr, Hinesville, Georgia |
| Authorized Official Name and Position | Karen Lynette Keene (VP CYBERSECURITY, IT SECURITY) |
| 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 Tennessee, Inc. 345 W Memorial Dr Hinesville GA 31313-2413 Ph: () - | Centerstone Of Tennessee, Inc. 345 W Memorial Dr Hinesville GA 31313-2413 Ph: (888) 291-4357 |
| NPI Number | 1376365197 |
|---|---|
| Provider Enumeration Date | 10/31/2024 |
| Last Update Date | 10/31/2024 |
| Certification Date | 10/31/2024 |
| Medicare PECOS PAC ID | 9739088113 |
|---|---|
| Medicare Enrollment ID | O20250205001564 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376365197 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Bridgette Cordova |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851011621 PECOS PAC ID: 6103360219 Enrollment ID: I20240701001093 |
| Provider Name | Deanna Iovino |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265988604 PECOS PAC ID: 4284092065 Enrollment ID: I20250205001717 |
| Provider Name | Theodore Allen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669041265 PECOS PAC ID: 9133659667 Enrollment ID: I20250212002468 |
| Provider Name | Scarlet Keck Chancey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730433079 PECOS PAC ID: 4981124997 Enrollment ID: I20250220003159 |
| Provider Name | Paige Simon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1407391337 PECOS PAC ID: 0941720460 Enrollment ID: I20250226003704 |
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