| Innersoul Collective Llc | |
|
2604 Hunters Pond Run Apt 32 Champaign IL 61820-2664 | |
| (773) 234-6869 | |
| Not Available |
| Full Name | Innersoul Collective Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2604 Hunters Pond Run Apt 32, Champaign, Illinois |
| Authorized Official Name and Position | Cashonna Berger (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 2177991809 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Innersoul Collective Llc 2005 N Prospect Ave # 1079 Champaign IL 61822-1235 Ph: () - | Innersoul Collective Llc 2604 Hunters Pond Run Apt 32 Champaign IL 61820-2664 Ph: (773) 234-6869 |
| NPI Number | 1003623869 |
|---|---|
| Provider Enumeration Date | 12/16/2024 |
| Last Update Date | 01/13/2025 |
| Certification Date | 01/13/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003623869 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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