| Cotswold Clinician Support Services | |
|
447 S Sharon Amity Rd Ste 250 Charlotte NC 28211-2889 | |
| (704) 264-2973 | |
| (980) 498-6700 |
| Full Name | Cotswold Clinician Support Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 447 S Sharon Amity Rd, Charlotte, North Carolina |
| Authorized Official Name and Position | Kimberly Matone (OWNER) |
| Authorized Official Contact | 7044934934 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cotswold Clinician Support Services 447 S Sharon Amity Rd Ste 250 Charlotte NC 28211-2889 Ph: (704) 264-2973 | Cotswold Clinician Support Services 447 S Sharon Amity Rd Ste 250 Charlotte NC 28211-2889 Ph: (704) 264-2973 |
| NPI Number | 1063893568 |
|---|---|
| Provider Enumeration Date | 06/11/2015 |
| Last Update Date | 05/05/2025 |
| Certification Date | 05/05/2025 |
| Medicare PECOS PAC ID | 3971884511 |
|---|---|
| Medicare Enrollment ID | O20161220000490 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063893568 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Karen Sue Sumner Matson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104921717 PECOS PAC ID: 4082995634 Enrollment ID: I20161220000817 |
| Provider Name | Blair Hamel |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1225319544 PECOS PAC ID: 4880969005 Enrollment ID: I20171013000798 |
| Provider Name | David Lynn |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1033162227 PECOS PAC ID: 3375528722 Enrollment ID: I20171023000005 |
| Provider Name | Angela Bean Chop |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679727226 PECOS PAC ID: 4587924337 Enrollment ID: I20180216000003 |
| Provider Name | Carmen Samyra Edwards |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679922827 PECOS PAC ID: 9032468426 Enrollment ID: I20180817001864 |
| Provider Name | Josefine Marie Eriksson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1194335935 PECOS PAC ID: 3274951751 Enrollment ID: I20200915002652 |
| Provider Name | Kelsey Crowe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881022176 PECOS PAC ID: 8921417445 Enrollment ID: I20210512002096 |
| Provider Name | Jessica Renee Swanson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407313596 PECOS PAC ID: 8022417369 Enrollment ID: I20210519000349 |
| Provider Name | Athena Dacanay |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1255853396 PECOS PAC ID: 9234404310 Enrollment ID: I20210720000899 |
| Provider Name | Patrice Wright |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245890557 PECOS PAC ID: 5092113449 Enrollment ID: I20211014003248 |
| Provider Name | John P Brunelle |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891027819 PECOS PAC ID: 5799961058 Enrollment ID: I20220519000691 |
| Provider Name | Maggie Rose Timmerman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053913319 PECOS PAC ID: 5193188258 Enrollment ID: I20230823001429 |
| Provider Name | Carly Seymour |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1194373951 PECOS PAC ID: 7012371271 Enrollment ID: I20230907000607 |
| Provider Name | Elizabeth Leinbach |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790327245 PECOS PAC ID: 0345695839 Enrollment ID: I20231018004139 |
| Provider Name | Patricia Stewart |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447401146 PECOS PAC ID: 3375992282 Enrollment ID: I20231218000461 |
| Provider Name | Tricia Schmidt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326408790 PECOS PAC ID: 1052761392 Enrollment ID: I20231228001293 |
| Provider Name | Brian Collin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1811545890 PECOS PAC ID: 8628421856 Enrollment ID: I20240124002140 |
| Provider Name | Shirley Anne Miller |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1851642581 PECOS PAC ID: 8628421385 Enrollment ID: I20240129004122 |
| Provider Name | Jasmine Townsend |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497327811 PECOS PAC ID: 6406295617 Enrollment ID: I20240422000946 |
| Provider Name | Bonnie Elaine Phillips |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1366596058 PECOS PAC ID: 6901245067 Enrollment ID: I20240422003248 |
| Provider Name | John Samuel Caprell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1710371240 PECOS PAC ID: 7517307606 Enrollment ID: I20240507001309 |
| Provider Name | Sydney Alexandra Camargo |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053143958 PECOS PAC ID: 2769913417 Enrollment ID: I20241004001637 |
| Provider Name | Alexandra Lochan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912725789 PECOS PAC ID: 4688102247 Enrollment ID: I20250109002381 |
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