| Myspectrum Llc | |
|
707 N Courthouse Rd North Chesterfield VA 23236-4045 | |
| (804) 332-5696 | |
| (866) 626-4469 |
| Full Name | Myspectrum Llc |
|---|---|
| Speciality | Counselor |
| Location | 707 N Courthouse Rd, North Chesterfield, Virginia |
| Authorized Official Name and Position | Suzanne Christopher (DIRECTOR) |
| Authorized Official Contact | 8043325696 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Myspectrum Llc 707 N Courthouse Rd North Chesterfield VA 23236-4045 Ph: (804) 332-5696 | Myspectrum Llc 707 N Courthouse Rd North Chesterfield VA 23236-4045 Ph: (804) 332-5696 |
| NPI Number | 1174029359 |
|---|---|
| Provider Enumeration Date | 04/05/2018 |
| Last Update Date | 06/21/2019 |
| Medicare PECOS PAC ID | 5799027843 |
|---|---|
| Medicare Enrollment ID | O20190422001369 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174029359 | NPI | - | NPPES |
| 1174029359 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jeffrey A Fulmer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548527096 PECOS PAC ID: 8820303068 Enrollment ID: I20150817001595 |
| Provider Name | Terence D Reaves |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295106243 PECOS PAC ID: 0143521641 Enrollment ID: I20151228001544 |
| Provider Name | Jennifer V Ralsten |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699123745 PECOS PAC ID: 6901194919 Enrollment ID: I20161006001729 |
| Provider Name | Tierra Collins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215458542 PECOS PAC ID: 7719247634 Enrollment ID: I20180213002955 |
| Provider Name | Kevin B Hanger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942412234 PECOS PAC ID: 2062513302 Enrollment ID: I20190812002860 |
| Provider Name | Pamela M Heithaus |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730732280 PECOS PAC ID: 9537499405 Enrollment ID: I20190919003288 |
| Provider Name | Sharon Theiner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235799214 PECOS PAC ID: 2860722006 Enrollment ID: I20191001001901 |
| Provider Name | George Deshazor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497345078 PECOS PAC ID: 4880008374 Enrollment ID: I20210125000581 |
| Provider Name | Regina Mcnamara |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295107555 PECOS PAC ID: 1658601570 Enrollment ID: I20210302003006 |
| Provider Name | Rachael Reeder |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801228044 PECOS PAC ID: 1658787411 Enrollment ID: I20210303001365 |
| Provider Name | Jillian Giannelli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013526599 PECOS PAC ID: 0547676264 Enrollment ID: I20210304000514 |
| Provider Name | Erin Mcmenamin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003475575 PECOS PAC ID: 1153737812 Enrollment ID: I20210304001836 |
| Provider Name | Tamara Blau |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124633078 PECOS PAC ID: 9234545849 Enrollment ID: I20210305001687 |
| Provider Name | Anthony Clark |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902497977 PECOS PAC ID: 3577971399 Enrollment ID: I20210415002690 |
| Provider Name | Elaine S Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780156521 PECOS PAC ID: 6800204629 Enrollment ID: I20210415002918 |
| Provider Name | Katherine Mavis Leahey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164091575 PECOS PAC ID: 7719383124 Enrollment ID: I20210910001058 |
| Provider Name | Eryn Paxton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538836580 PECOS PAC ID: 5799181038 Enrollment ID: I20210910002539 |
| Provider Name | Tiffany Barnhard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922407469 PECOS PAC ID: 4789087305 Enrollment ID: I20220322002713 |
| Provider Name | Jennifer Cezar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326408907 PECOS PAC ID: 8921360439 Enrollment ID: I20230425000215 |
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