| Chronic Illness Counseling Center Llc | |
|
914 Lily Creek Rd Ste 101 Louisville KY 40243-2815 | |
| (502) 805-5858 | |
| (502) 805-5859 |
| Full Name | Chronic Illness Counseling Center Llc |
|---|---|
| Speciality | Social Worker |
| Location | 914 Lily Creek Rd Ste 101, Louisville, Kentucky |
| Authorized Official Name and Position | Jayan Thomas (OWNER/SOLE MEMBER) |
| Authorized Official Contact | 5028055858 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chronic Illness Counseling Center Llc 4103 Brownsboro Glen Rd Louisville KY 40241-1196 Ph: (502) 558-0696 | Chronic Illness Counseling Center Llc 914 Lily Creek Rd Ste 101 Louisville KY 40243-2815 Ph: (502) 805-5858 |
| NPI Number | 1548839285 |
|---|---|
| Provider Enumeration Date | 06/17/2021 |
| Last Update Date | 06/17/2021 |
| Certification Date | 06/17/2021 |
| Medicare PECOS PAC ID | 3274930896 |
|---|---|
| Medicare Enrollment ID | O20210924001452 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548839285 | NPI | - | NPPES |
| 1609989151 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jayan E Thomas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609989151 PECOS PAC ID: 3678757705 Enrollment ID: I20110413000825 |
| Provider Name | Catherine L Stone Hahn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962892125 PECOS PAC ID: 7012277338 Enrollment ID: I20180207000254 |
| Provider Name | Jennifer Hamill |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184192429 PECOS PAC ID: 8426392556 Enrollment ID: I20181130001147 |
| Provider Name | Robbie B Blair |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659636199 PECOS PAC ID: 6204162662 Enrollment ID: I20190724000724 |
| Provider Name | Niyabinghi N Thomas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437803632 PECOS PAC ID: 0345636817 Enrollment ID: I20220408002337 |
| Provider Name | Regina Bramer Wheatley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023484474 PECOS PAC ID: 4688060932 Enrollment ID: I20220413001781 |
| Provider Name | Samiyra N Shabazz-dixon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518547744 PECOS PAC ID: 1658741319 Enrollment ID: I20221221002861 |
| Provider Name | Samantha Kaye Goodwin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407502602 PECOS PAC ID: 8123483617 Enrollment ID: I20230505002242 |
| Provider Name | Franchesca Yvette Brutley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1053923748 PECOS PAC ID: 5193161321 Enrollment ID: I20240311002744 |
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