| Loving Reconnections Behavioral Health Pa | |
|
110 Hepler St Suite B Kernersville NC 27284-2791 | |
| (336) 497-5701 | |
| Not Available |
| Full Name | Loving Reconnections Behavioral Health Pa |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 110 Hepler St, Kernersville, North Carolina |
| Authorized Official Name and Position | John Vincent Governale (PRACTICE MANAGER / VICE PRESIDENT) |
| Authorized Official Contact | 3364975701 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Loving Reconnections Behavioral Health Pa 110 Hepler St Suite B Kernersville NC 27284-2791 Ph: (336) 497-5701 | Loving Reconnections Behavioral Health Pa 110 Hepler St Suite B Kernersville NC 27284-2791 Ph: (336) 497-5701 |
| NPI Number | 1053861641 |
|---|---|
| Provider Enumeration Date | 10/07/2016 |
| Last Update Date | 01/23/2017 |
| Medicare PECOS PAC ID | 3971884107 |
|---|---|
| Medicare Enrollment ID | O20170103000000 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053861641 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | C010334 (North Carolina) | Primary |
| Provider Name | Sarah A Solomon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144576810 PECOS PAC ID: 3476700790 Enrollment ID: I20120821000984 |
| Provider Name | Rebecca Kaye Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447702063 PECOS PAC ID: 0345521399 Enrollment ID: I20170105000666 |
| Provider Name | Joann Marie Governale |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568709756 PECOS PAC ID: 4880975010 Enrollment ID: I20170105001933 |
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