| Intercept Youth Services, Inc | |
|
5673 Airport Rd Roanoke VA 24012-1119 | |
| (540) 523-8080 | |
| (540) 512-9775 |
| Full Name | Intercept Youth Services, Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5673 Airport Rd, Roanoke, Virginia |
| Authorized Official Name and Position | Don Kamencik (CFO) |
| Authorized Official Contact | 8048641320 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Intercept Youth Services, Inc 5511 Staples Mill Rd Ste 102 Richmond VA 23228-5445 Ph: (804) 864-1320 | Intercept Youth Services, Inc 5673 Airport Rd Roanoke VA 24012-1119 Ph: (540) 523-8080 |
| NPI Number | 1730608217 |
|---|---|
| Provider Enumeration Date | 09/15/2017 |
| Last Update Date | 04/08/2024 |
| Certification Date | 04/08/2024 |
| Medicare PECOS PAC ID | 2466748744 |
|---|---|
| Medicare Enrollment ID | O20160913001490 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730608217 | NPI | - | NPPES |
| Provider Name | Mark D Martin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346490695 PECOS PAC ID: 0749502565 Enrollment ID: I20141205002124 |
| Provider Name | Joseph Waheb Iskandar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215252143 PECOS PAC ID: 1557505823 Enrollment ID: I20150403000655 |
| Provider Name | Leanna M Stone |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194355024 PECOS PAC ID: 3476983867 Enrollment ID: I20200427001818 |
| Provider Name | James Kp Terry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134777261 PECOS PAC ID: 5092111435 Enrollment ID: I20210909001885 |
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