| Inner Peace Therapeutic Services, Llc | |
|
22776 Three Notch Rd Ste 210 Lexington Park MD 20653-3370 | |
| (301) 866-6333 | |
| (240) 718-1906 |
| Full Name | Inner Peace Therapeutic Services, Llc |
|---|---|
| Speciality | Counselor |
| Location | 22776 Three Notch Rd Ste 210, Lexington Park, Maryland |
| Authorized Official Name and Position | Jacqueline Dale Grantland (OWNER) |
| Authorized Official Contact | 3018666333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Inner Peace Therapeutic Services, Llc Po Box 1662 Lexington Park MD 20653-1662 Ph: (240) 718-8460 | Inner Peace Therapeutic Services, Llc 22776 Three Notch Rd Ste 210 Lexington Park MD 20653-3370 Ph: (301) 866-6333 |
| NPI Number | 1710303573 |
|---|---|
| Provider Enumeration Date | 03/17/2014 |
| Last Update Date | 02/02/2024 |
| Certification Date | 02/02/2024 |
| Medicare PECOS PAC ID | 4688012883 |
|---|---|
| Medicare Enrollment ID | O20240408001258 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710303573 | NPI | - | NPPES |
| 6103219 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | LC4189 (Maryland) | Primary |
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