| Virginia Center For Addiction Medicine | |
|
4212 Park Place Ct Glen Allen VA 23060-3314 | |
| (804) 332-5950 | |
| (804) 728-1086 |
| Full Name | Virginia Center For Addiction Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 4212 Park Place Ct, Glen Allen, Virginia |
| Authorized Official Name and Position | James Edward Thompson (CMO) |
| Authorized Official Contact | 8043325950 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Virginia Center For Addiction Medicine 4212 Park Place Ct Glen Allen VA 23060-3314 Ph: (804) 332-5950 | Virginia Center For Addiction Medicine 4212 Park Place Ct Glen Allen VA 23060-3314 Ph: (804) 332-5950 |
| NPI Number | 1477091247 |
|---|---|
| Provider Enumeration Date | 02/01/2017 |
| Last Update Date | 01/04/2021 |
| Certification Date | 01/04/2021 |
| Medicare PECOS PAC ID | 4789960055 |
|---|---|
| Medicare Enrollment ID | O20170421001009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477091247 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | 0101015030 (Virginia) | Secondary |
| 207RA0401X | Internal Medicine - Addiction Medicine | 0101246355 (Virginia) | Primary |
| Provider Name | James E Thompson |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1194913533 PECOS PAC ID: 5799970166 Enrollment ID: I20101110001382 |
| Provider Name | Mary E Bowman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770869406 PECOS PAC ID: 0749429603 Enrollment ID: I20150930002863 |
| Provider Name | Kira M Bleecher |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1164868469 PECOS PAC ID: 4385983568 Enrollment ID: I20190306000371 |
| Provider Name | Shannon L Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023511540 PECOS PAC ID: 3678812864 Enrollment ID: I20190306000714 |
| Provider Name | Winter Marie Mcfarland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023585619 PECOS PAC ID: 7618219239 Enrollment ID: I20190501002347 |
| Provider Name | Marci Lynn Waggoner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164884714 PECOS PAC ID: 8820408222 Enrollment ID: I20201112002658 |
| Provider Name | Alecia Sheree Ball |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558906313 PECOS PAC ID: 6204235229 Enrollment ID: I20210525001059 |
| Provider Name | Brittany N Ilagan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932871472 PECOS PAC ID: 4385024397 Enrollment ID: I20220708000993 |
| Provider Name | Kimberly Kaminer |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1548204084 PECOS PAC ID: 2961526207 Enrollment ID: I20220930000852 |
| Provider Name | Charlotte Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992253934 PECOS PAC ID: 9739457284 Enrollment ID: I20230825000349 |
| Provider Name | Keeley Grimm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619656386 PECOS PAC ID: 9234587890 Enrollment ID: I20231121001771 |
| Provider Name | Katherine Louise Haskins |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033983077 PECOS PAC ID: 2062857683 Enrollment ID: I20240305001317 |
| Provider Name | Andreas Bienert |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821503160 PECOS PAC ID: 1557706181 Enrollment ID: I20240305001548 |
| Provider Name | Justin Jackson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235788902 PECOS PAC ID: 7113362757 Enrollment ID: I20240305001845 |
| Provider Name | Loren Walden Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588242044 PECOS PAC ID: 3476951344 Enrollment ID: I20240501002341 |
| Provider Name | Paula Lynch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629686704 PECOS PAC ID: 2466992821 Enrollment ID: I20240911004427 |
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