| Sane Space | |
|
4420 Rosemar Ctr Ste 201c Parkersburg WV 26104-1255 | |
| (304) 220-0041 | |
| (304) 220-0112 |
| Full Name | Sane Space |
|---|---|
| Speciality | Psychologist |
| Location | 4420 Rosemar Ctr Ste 201c, Parkersburg, West Virginia |
| Authorized Official Name and Position | Christina Jackson (OWNER) |
| Authorized Official Contact | 3042200041 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sane Space 4420 Rosemar Ctr Ste 201c Parkersburg WV 26104-1255 Ph: (304) 220-0441 | Sane Space 4420 Rosemar Ctr Ste 201c Parkersburg WV 26104-1255 Ph: (304) 220-0041 |
| NPI Number | 1164118642 |
|---|---|
| Provider Enumeration Date | 04/17/2023 |
| Last Update Date | 10/19/2023 |
| Certification Date | 10/19/2023 |
| Medicare PECOS PAC ID | 1456710003 |
|---|---|
| Medicare Enrollment ID | O20230629003732 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164118642 | NPI | - | NPPES |
| Provider Name | Kendra Ann Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730314725 PECOS PAC ID: 8820058621 Enrollment ID: I20041015000639 |
| Provider Name | Christina Jackson |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1083825897 PECOS PAC ID: 2365801917 Enrollment ID: I20230629003790 |
| Provider Name | Nancy Creighton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568942894 PECOS PAC ID: 7113375684 Enrollment ID: I20231121002861 |
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