| Pro-therapy, Llc | |
|
3316 Longstreet Dr Petersburg VA 23805-2641 | |
| (804) 721-3306 | |
| Not Available |
| Full Name | Pro-therapy, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3316 Longstreet Dr, Petersburg, Virginia |
| Authorized Official Name and Position | Tanikka L Mason (CHIEF CLINICAL OFFICER) |
| Authorized Official Contact | 8047213306 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pro-therapy, Llc Po Box 3405 Glen Allen VA 23058-3405 Ph: (804) 721-3306 | Pro-therapy, Llc 3316 Longstreet Dr Petersburg VA 23805-2641 Ph: (804) 721-3306 |
| NPI Number | 1144069667 |
|---|---|
| Provider Enumeration Date | 05/23/2024 |
| Last Update Date | 05/23/2024 |
| Certification Date | 05/23/2024 |
| Medicare PECOS PAC ID | 4486182151 |
|---|---|
| Medicare Enrollment ID | O20250108002343 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144069667 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Tanikka Mason |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659731131 PECOS PAC ID: 9234405721 Enrollment ID: I20171027002490 |
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