| Wishing Well Counseling Center, Pllc | |
|
707 Gittings St Suite 120 Suffolk VA 23434-6101 | |
| (757) 514-3428 | |
| (757) 514-3428 |
| Full Name | Wishing Well Counseling Center, Pllc |
|---|---|
| Speciality | Counselor |
| Location | 707 Gittings St, Suffolk, Virginia |
| Authorized Official Name and Position | Mansherees Leann Ward (OWNER/THERAPIST) |
| Authorized Official Contact | 7573091510 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wishing Well Counseling Center, Pllc 707 Gittings St Suite 120 Suffolk VA 23434-6101 Ph: (757) 514-3428 | Wishing Well Counseling Center, Pllc 707 Gittings St Suite 120 Suffolk VA 23434-6101 Ph: (757) 514-3428 |
| NPI Number | 1689042780 |
|---|---|
| Provider Enumeration Date | 09/04/2015 |
| Last Update Date | 02/01/2022 |
| Certification Date | 01/26/2022 |
| Medicare PECOS PAC ID | 7113311424 |
|---|---|
| Medicare Enrollment ID | O20220303000133 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689042780 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 0701005261 (Virginia) | Primary |
| Provider Name | Rebecca L Mccullar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205026127 PECOS PAC ID: 6002091113 Enrollment ID: I20220303000185 |
| Provider Name | Amanda Helen Deselding |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316683014 PECOS PAC ID: 0840672135 Enrollment ID: I20220803001187 |
| Provider Name | Helen Kafer Varnadoe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205847324 PECOS PAC ID: 6305949017 Enrollment ID: I20230417002187 |
| Provider Name | Erin Marie Gossage |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326491523 PECOS PAC ID: 0840684155 Enrollment ID: I20240109001312 |
| Provider Name | Lauren Marie Overman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235473117 PECOS PAC ID: 8022402338 Enrollment ID: I20240307000782 |
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