| Inner Peace Community Support Services Llc | |
|
3005 Village Park Dr Ste 204 Knightdale NC 27545-7993 | |
| (919) 944-3130 | |
| (919) 944-3131 |
| Full Name | Inner Peace Community Support Services Llc |
|---|---|
| Speciality | Social Worker |
| Location | 3005 Village Park Dr Ste 204, Knightdale, North Carolina |
| Authorized Official Name and Position | Darrell Tennie (MANAGING DIRECTOR) |
| Authorized Official Contact | 9192170933 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Inner Peace Community Support Services Llc 3005 Village Park Dr Ste 204 Knightdale NC 27545-7993 Ph: (919) 944-3130 | Inner Peace Community Support Services Llc 3005 Village Park Dr Ste 204 Knightdale NC 27545-7993 Ph: (919) 944-3130 |
| NPI Number | 1952681140 |
|---|---|
| Provider Enumeration Date | 08/19/2011 |
| Last Update Date | 03/16/2017 |
| Medicare PECOS PAC ID | 8628217049 |
|---|---|
| Medicare Enrollment ID | O20130615000186 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952681140 | NPI | - | NPPES |
| 6008780 | Medicaid | NC | |
| GP6439 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C006312 (North Carolina) | Primary |
| 1041C0700X | Social Worker - Clinical | 9742 (South Carolina) | Secondary |
| Provider Name | David Cleo Cook |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669412375 PECOS PAC ID: 7810955895 Enrollment ID: I20041221001060 |
| Provider Name | Sharon V Hartzog |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073714036 PECOS PAC ID: 2466626593 Enrollment ID: I20111129000376 |
| Provider Name | Datanya Y Betts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639501539 PECOS PAC ID: 1951532092 Enrollment ID: I20140402002003 |
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