| Inner Transformation Therapeutic Services, Pllc | |
|
10130 Perimeter Parkway Suite 200 - #0425 Charlotte NC 28216 | |
| (980) 230-8880 | |
| (844) 841-1302 |
| Full Name | Inner Transformation Therapeutic Services, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 10130 Perimeter Parkway Suite 200 - #0425, Charlotte, North Carolina |
| Authorized Official Name and Position | Correlia D Johnson (OWNER) |
| Authorized Official Contact | 9802308880 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Inner Transformation Therapeutic Services, Pllc 10130 Perimeter Parkway Suite 200 - #0425 Charlotte NC 28216 Ph: (980) 230-8880 | Inner Transformation Therapeutic Services, Pllc 10130 Perimeter Parkway Suite 200 - #0425 Charlotte NC 28216 Ph: (980) 230-8880 |
| NPI Number | 1619384583 |
|---|---|
| Provider Enumeration Date | 07/12/2014 |
| Last Update Date | 08/26/2022 |
| Certification Date | 08/26/2022 |
| Medicare PECOS PAC ID | 1658596390 |
|---|---|
| Medicare Enrollment ID | O20140714000096 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619384583 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Correlia D Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033490115 PECOS PAC ID: 5294950937 Enrollment ID: I20140714000120 |
| Provider Name | Tiaira Robinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639626047 PECOS PAC ID: 2769739309 Enrollment ID: I20180727001155 |
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