| Inner Source Therapy, Pllc | |
|
790 Cardinal Rd New Bern NC 28562-5202 | |
| (252) 658-0565 | |
| (252) 636-1100 |
| Full Name | Inner Source Therapy, Pllc |
|---|---|
| Speciality | Counselor |
| Location | 790 Cardinal Rd, New Bern, North Carolina |
| Authorized Official Name and Position | Deborah J Ashway (OWNER) |
| Authorized Official Contact | 2526580565 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Inner Source Therapy, Pllc 261 Goose Creek Rd New Bern NC 28562-3667 Ph: (252) 658-0565 | Inner Source Therapy, Pllc 790 Cardinal Rd New Bern NC 28562-5202 Ph: (252) 658-0565 |
| NPI Number | 1831867175 |
|---|---|
| Provider Enumeration Date | 09/01/2021 |
| Last Update Date | 09/03/2021 |
| Certification Date | 09/03/2021 |
| Medicare PECOS PAC ID | 1153771787 |
|---|---|
| Medicare Enrollment ID | O20240410001787 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831867175 | NPI | - | NPPES |
| 1194134619 | Other | NC | MENTAL HEALTH THERAPISTS, LCMHC, LCAS |
| 1750886826 | Other | NC | MENTAL HEALTH THERAPISTS, LCMHC, LCAS |
| 1770780025 | Other | NC | MENTAL HEALTH THERAPISTS, LCMHC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Deborah Ashway |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194134619 PECOS PAC ID: 1355789256 Enrollment ID: I20240410001883 |
| Provider Name | Jessica Elizabeth Whittington |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003154634 PECOS PAC ID: 1456790500 Enrollment ID: I20240422002782 |
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