| Positive Innergy Counseling Services, Llc | |
|
6562 King Rd Meridian MS 39305-8364 | |
| (601) 917-0271 | |
| Not Available |
| Full Name | Positive Innergy Counseling Services, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6562 King Rd, Meridian, Mississippi |
| Authorized Official Name and Position | Oya Weston Hampton (LICENSED PROFESSIONAL COUNSELOR) |
| Authorized Official Contact | 6019170271 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Positive Innergy Counseling Services, Llc Po Box 4523 Meridian MS 39304-4523 Ph: (601) 917-0271 | Positive Innergy Counseling Services, Llc 6562 King Rd Meridian MS 39305-8364 Ph: (601) 917-0271 |
| NPI Number | 1003432626 |
|---|---|
| Provider Enumeration Date | 06/19/2020 |
| Last Update Date | 06/20/2020 |
| Certification Date | 06/20/2020 |
| Medicare PECOS PAC ID | 6204298367 |
|---|---|
| Medicare Enrollment ID | O20230823003145 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003432626 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Tina Darlene Clearman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700142403 PECOS PAC ID: 4789846676 Enrollment ID: I20120511000025 |
| Provider Name | Tabitha Harper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801375894 PECOS PAC ID: 9537408554 Enrollment ID: I20190308000119 |
| Provider Name | Derrick Pringle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518481480 PECOS PAC ID: 0840532719 Enrollment ID: I20190424001198 |
| Provider Name | Sherita Danielle Wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225502412 PECOS PAC ID: 6103168083 Enrollment ID: I20190424001787 |
| Provider Name | Kristen M Thames |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407493596 PECOS PAC ID: 5698101798 Enrollment ID: I20200210001003 |
| Provider Name | Danielle Pugh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639718455 PECOS PAC ID: 4082044136 Enrollment ID: I20210922001037 |
| Provider Name | Susan L Shaw |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225795859 PECOS PAC ID: 3678964244 Enrollment ID: I20211216000247 |
| Provider Name | Miquell Mcglothin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952618837 PECOS PAC ID: 1759730211 Enrollment ID: I20240308000449 |
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