| County Line Enhancement Services | |
|
620 County Line Rd Bassett VA 24055-5157 | |
| (276) 790-7497 | |
| Not Available |
| Full Name | County Line Enhancement Services |
|---|---|
| Speciality | Counselor |
| Location | 620 County Line Rd, Bassett, Virginia |
| Authorized Official Name and Position | Aleta Gibbs (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2767907497 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| County Line Enhancement Services 620 County Line Rd Bassett VA 24055-5157 Ph: () - | County Line Enhancement Services 620 County Line Rd Bassett VA 24055-5157 Ph: (276) 790-7497 |
| NPI Number | 1861153173 |
|---|---|
| Provider Enumeration Date | 01/08/2022 |
| Last Update Date | 01/08/2022 |
| Certification Date | 01/08/2022 |
| Medicare PECOS PAC ID | 4082145826 |
|---|---|
| Medicare Enrollment ID | O20241003000922 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861153173 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| Provider Name | Aleta Gibbs |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861059628 PECOS PAC ID: 6800327644 Enrollment ID: I20241003001471 |
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County Line Counselors Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 620 County Line Rd, Bassett, VA 24055 Phone: 276-790-7497 |