| Pivots Potential | |
|
917 Hoffmaster Rd Knoxville MD 21758-1216 | |
| (888) 458-5199 | |
| (240) 337-8598 |
| Full Name | Pivots Potential |
|---|---|
| Speciality | Social Worker |
| Location | 917 Hoffmaster Rd, Knoxville, Maryland |
| Authorized Official Name and Position | Vida Lynne Penn-leon (EXECUTIVE OFFICER) |
| Authorized Official Contact | 4108683498 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pivots Potential 1631 Wesel Blvd # 1047 Hagerstown MD 21740-5387 Ph: (888) 458-5199 | Pivots Potential 917 Hoffmaster Rd Knoxville MD 21758-1216 Ph: (888) 458-5199 |
| NPI Number | 1659097525 |
|---|---|
| Provider Enumeration Date | 10/12/2022 |
| Last Update Date | 02/10/2025 |
| Certification Date | 02/10/2025 |
| Medicare PECOS PAC ID | 5799152724 |
|---|---|
| Medicare Enrollment ID | O20221104000649 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659097525 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Vida Lynne Penn-leon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225150980 PECOS PAC ID: 6608243639 Enrollment ID: I20221104000873 |
Centrepointe Counseling, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2212 Jefferson Pike, Knoxville, MD 21758 Phone: 800-491-5369 Fax: 301-774-3678 |