| Greenville Mental Health Center | |
|
124 Mallard St Greenville SC 29601-4046 | |
| (864) 241-1040 | |
| (864) 241-1215 |
| Full Name | Greenville Mental Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 124 Mallard St, Greenville, South Carolina |
| Authorized Official Name and Position | Jennifer Crowe (BILLING) |
| Authorized Official Contact | 8642411040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Greenville Mental Health Center 124 Mallard St Greenville SC 29601-4046 Ph: (864) 241-1040 | Greenville Mental Health Center 124 Mallard St Greenville SC 29601-4046 Ph: (864) 241-1040 |
| NPI Number | 1619995370 |
|---|---|
| Provider Enumeration Date | 07/18/2006 |
| Last Update Date | 12/18/2023 |
| Certification Date | 12/18/2023 |
| Medicare PECOS PAC ID | 9032021175 |
|---|---|
| Medicare Enrollment ID | O20040624000139 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619995370 | NPI | - | NPPES |
| 301100 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Kenneth Rogers |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205844669 PECOS PAC ID: 2668375411 Enrollment ID: I20040129000246 |
| Provider Name | Deborah Dobson Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437131257 PECOS PAC ID: 6901898998 Enrollment ID: I20040331000638 |
| Provider Name | Sunil Kumar Bhatia |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538173109 PECOS PAC ID: 5890770663 Enrollment ID: I20040624000310 |
| Provider Name | Renu Bhatia |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093817058 PECOS PAC ID: 4486622164 Enrollment ID: I20040921000279 |
| Provider Name | Vonda K Gravely |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053382259 PECOS PAC ID: 3870554322 Enrollment ID: I20041019001028 |
| Provider Name | Alfred C Edwards |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952315780 PECOS PAC ID: 9133104987 Enrollment ID: I20050216000679 |
| Provider Name | Lisa Lewandowski Wischhusen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982645016 PECOS PAC ID: 2860422961 Enrollment ID: I20050818000312 |
| Provider Name | Ervin D Prewette |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851303200 PECOS PAC ID: 9830197110 Enrollment ID: I20061121000142 |
| Provider Name | Lynn P Wright |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346332137 PECOS PAC ID: 5092715763 Enrollment ID: I20070102000354 |
| Provider Name | Elena Dlugach |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740393206 PECOS PAC ID: 8628138955 Enrollment ID: I20081117000651 |
| Provider Name | Michael N Tran |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952513830 PECOS PAC ID: 5890829279 Enrollment ID: I20100820000589 |
| Provider Name | Maureen A Burbage |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871746396 PECOS PAC ID: 1850563198 Enrollment ID: I20111011000489 |
| Provider Name | Evan L Vogel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235143066 PECOS PAC ID: 0547435000 Enrollment ID: I20111212000299 |
| Provider Name | William D Taylor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184717001 PECOS PAC ID: 3274708789 Enrollment ID: I20111213000003 |
| Provider Name | Eunice Peterson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164547683 PECOS PAC ID: 8729253091 Enrollment ID: I20111215000012 |
| Provider Name | Taralkumar R Sharma |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710121009 PECOS PAC ID: 0244473734 Enrollment ID: I20130903000199 |
| Provider Name | Clare H Mclain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891716825 PECOS PAC ID: 2062644560 Enrollment ID: I20140416001059 |
| Provider Name | Eve Ariel Fields |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417052234 PECOS PAC ID: 9739281486 Enrollment ID: I20160614002123 |
| Provider Name | Laureen J Noll |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144271867 PECOS PAC ID: 5294788691 Enrollment ID: I20170718000253 |
| Provider Name | Dorothy A Burkett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588173124 PECOS PAC ID: 4082975917 Enrollment ID: I20180309000971 |
| Provider Name | Geetika Dembla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164626875 PECOS PAC ID: 1456548890 Enrollment ID: I20180515000509 |
| Provider Name | Shane Maurice Carswell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407367303 PECOS PAC ID: 8224384276 Enrollment ID: I20180703003094 |
| Provider Name | Ronald Caudill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457831539 PECOS PAC ID: 7618217951 Enrollment ID: I20190322000847 |
| Provider Name | Lori Heppard Grant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518954478 PECOS PAC ID: 9739161886 Enrollment ID: I20190618000175 |
| Provider Name | Michael Anthony Sierra |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720491640 PECOS PAC ID: 8022307842 Enrollment ID: I20190909003846 |
| Provider Name | Erin Marie Mcgeachie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801452149 PECOS PAC ID: 2860814233 Enrollment ID: I20200612002034 |
| Provider Name | Lauren H Levy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104276641 PECOS PAC ID: 4486949815 Enrollment ID: I20201013003247 |
| Provider Name | Kristal Turner Tribble |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376931824 PECOS PAC ID: 5395134951 Enrollment ID: I20211119001677 |
| Provider Name | Samuel E Payne |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548307655 PECOS PAC ID: 4880088194 Enrollment ID: I20220303000007 |
| Provider Name | Lindsey Erin Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811364961 PECOS PAC ID: 9436592169 Enrollment ID: I20240208003940 |
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