| Coastal Carolina Neuropsychiatric Center, Pa | |
|
200 Tarpon Trail Jacksonville NC 28546-5266 | |
| (910) 938-1114 | |
| (910) 938-1118 |
| Full Name | Coastal Carolina Neuropsychiatric Center, Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 200 Tarpon Trail, Jacksonville, North Carolina |
| Authorized Official Name and Position | Carla Mikhail (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 9109381114 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Carolina Neuropsychiatric Center, Pa 200 Tarpon Trail Jacksonville NC 28546-5266 Ph: (910) 938-1114 | Coastal Carolina Neuropsychiatric Center, Pa 200 Tarpon Trail Jacksonville NC 28546-5266 Ph: (910) 938-1114 |
| NPI Number | 1184737462 |
|---|---|
| Provider Enumeration Date | 08/17/2006 |
| Last Update Date | 08/05/2020 |
| Certification Date | 08/05/2020 |
| Medicare PECOS PAC ID | 5890794689 |
|---|---|
| Medicare Enrollment ID | O20061205000123 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184737462 | NPI | - | NPPES |
| Provider Name | Ashraf G Mikhail |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083690515 PECOS PAC ID: 0749274967 Enrollment ID: I20040412000817 |
| Provider Name | Antonio Cusi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487643151 PECOS PAC ID: 7911972187 Enrollment ID: I20040831000961 |
| Provider Name | Ajay K Veeragandham |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558467571 PECOS PAC ID: 8820005820 Enrollment ID: I20060316000212 |
| Provider Name | Susan L Rutherford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700981008 PECOS PAC ID: 1355341199 Enrollment ID: I20070102000134 |
| Provider Name | Timothy W Campbell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295896603 PECOS PAC ID: 3779680145 Enrollment ID: I20070518000328 |
| Provider Name | Amy R Hall |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487677399 PECOS PAC ID: 9931295425 Enrollment ID: I20071015000138 |
| Provider Name | Haresh Md Tharwani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790869618 PECOS PAC ID: 5496843088 Enrollment ID: I20071115000214 |
| Provider Name | Marie Belanger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275591703 PECOS PAC ID: 1850460080 Enrollment ID: I20080514000461 |
| Provider Name | Lee R Walker |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487723383 PECOS PAC ID: 8921170606 Enrollment ID: I20080714000079 |
| Provider Name | Alan J Crist |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902052376 PECOS PAC ID: 1951467778 Enrollment ID: I20090303000575 |
| Provider Name | Kristina A Hobby |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629223342 PECOS PAC ID: 6800936303 Enrollment ID: I20091214000618 |
| Provider Name | Dorinda D Dew |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528171139 PECOS PAC ID: 0244368553 Enrollment ID: I20100506000938 |
| Provider Name | Melvin W James |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912217712 PECOS PAC ID: 6204020084 Enrollment ID: I20101105000468 |
| Provider Name | Diane Cathleen Lee |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326338583 PECOS PAC ID: 6002087905 Enrollment ID: I20110927000003 |
| Provider Name | Delores E Brown |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245301803 PECOS PAC ID: 2365354586 Enrollment ID: I20120329000517 |
| Provider Name | Emily J Sinning-sewell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649528415 PECOS PAC ID: 2567610769 Enrollment ID: I20120913000040 |
| Provider Name | Jessica C Spaeth |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689004350 PECOS PAC ID: 9032347018 Enrollment ID: I20140121000976 |
| Provider Name | Sharon M Kahler |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215170394 PECOS PAC ID: 4284853417 Enrollment ID: I20140919001340 |
| Provider Name | Lourdes T Illa-sanchez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952317109 PECOS PAC ID: 8123144482 Enrollment ID: I20140923000227 |
| Provider Name | Amy Locklear |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356722946 PECOS PAC ID: 7214246164 Enrollment ID: I20151016000412 |
| Provider Name | Carissa J Marsh |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093268633 PECOS PAC ID: 2062700909 Enrollment ID: I20161010001712 |
| Provider Name | Stephen David Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720322688 PECOS PAC ID: 5991082679 Enrollment ID: I20170505001466 |
| Provider Name | Lisa Ann Mobley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700069044 PECOS PAC ID: 9436218054 Enrollment ID: I20171129003107 |
| Provider Name | Angela Gannon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740481431 PECOS PAC ID: 3173686284 Enrollment ID: I20181018001727 |
| Provider Name | Lindsay Lee Gonyeau |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558927368 PECOS PAC ID: 4486988615 Enrollment ID: I20190621002376 |
| Provider Name | Terra Griggs Garland |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851820138 PECOS PAC ID: 0143557272 Enrollment ID: I20190812002036 |
| Provider Name | Gina Marie Zotz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356862718 PECOS PAC ID: 5395075691 Enrollment ID: I20190930002975 |
| Provider Name | Justin R Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669882122 PECOS PAC ID: 2466752969 Enrollment ID: I20200107001982 |
| Provider Name | Mona S. Ismail |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053355834 PECOS PAC ID: 5294778593 Enrollment ID: I20201006000838 |
| Provider Name | Sarah Lynn Sarubbi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1245582956 PECOS PAC ID: 2567872609 Enrollment ID: I20201102000609 |
| Provider Name | Emily Kate Neuman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043854631 PECOS PAC ID: 4385058940 Enrollment ID: I20210122001908 |
| Provider Name | Natalie Cross |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558870659 PECOS PAC ID: 8729495718 Enrollment ID: I20210317002912 |
| Provider Name | Christopher Weston Harris |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851716831 PECOS PAC ID: 8426451956 Enrollment ID: I20210721003603 |
| Provider Name | Pamela Autry Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467197301 PECOS PAC ID: 0941688170 Enrollment ID: I20221020000457 |
| Provider Name | Michael Bradshaw |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104311539 PECOS PAC ID: 9133452675 Enrollment ID: I20221020001624 |
| Provider Name | Stephanny Parker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043978703 PECOS PAC ID: 3476940321 Enrollment ID: I20221021001050 |
| Provider Name | James Christensen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962609875 PECOS PAC ID: 7012074032 Enrollment ID: I20221103002932 |
| Provider Name | Andrea Jean Nelsen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043442700 PECOS PAC ID: 0749423770 Enrollment ID: I20230110001359 |
| Provider Name | Sara Nicole Brame |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467179994 PECOS PAC ID: 6507211521 Enrollment ID: I20231011003023 |
| Provider Name | Nicole Dunnigan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578349619 PECOS PAC ID: 5799133864 Enrollment ID: I20231129003924 |
| Provider Name | Joemel Jay Mediavilla Baloyo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588437065 PECOS PAC ID: 2860841251 Enrollment ID: I20231211002179 |
| Provider Name | Lori Wheeler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417483439 PECOS PAC ID: 1951751205 Enrollment ID: I20231228001824 |
| Provider Name | Tanya Jean Hopkins |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1205244464 PECOS PAC ID: 6800246851 Enrollment ID: I20240103001596 |
| Provider Name | Olivia Marie Corallo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447821145 PECOS PAC ID: 5698127686 Enrollment ID: I20240116000054 |
Bta Counseling & Consulting, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1106 Gum Branch Rd, Jacksonville, NC 28540 Phone: 910-370-1333 Fax: 910-356-9163 | |
Jacksonville Bhs Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 215 Memorial Dr, Jacksonville, NC 28546 Phone: 910-353-5118 | |
Light To My Path Therapeutic Services Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 99 Village Dr Ste 15, Jacksonville, NC 28546 Phone: 910-455-1922 Fax: 910-455-1921 | |
Healing Hearts Therapeutic Services, Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 824 Gum Branch Rd Ste E, Jacksonville, NC 28540 Phone: 910-347-1694 Fax: 910-347-3691 | |
A Step Above Therapeutic Services, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 200 Valencia Dr, Suite 127, Jacksonville, NC 28546 Phone: 910-938-1300 Fax: 910-938-2900 | |
R & R Counseling Services Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 445 Western Blvd, Suite Q, Jacksonville, NC 28546 Phone: 336-409-1551 | |
Pivotal Step Services, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1106b Gum Branch Rd, Jacksonville, NC 28540 Phone: 910-370-1333 Fax: 910-356-9163 |