Provider Demographics
NPI:1033549027
Name:INNER JOURNEYS COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:INNER JOURNEYS COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:MCGHEE
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-429-9675
Mailing Address - Street 1:410 PEACHTREE PKWY
Mailing Address - Street 2:BLDG 400, SUITE 4245
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7066
Mailing Address - Country:US
Mailing Address - Phone:678-429-9675
Mailing Address - Fax:678-341-5101
Practice Address - Street 1:410 PEACHTREE PKWY
Practice Address - Street 2:BLDG 400, SUITE 4245
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7066
Practice Address - Country:US
Practice Address - Phone:678-429-9675
Practice Address - Fax:678-341-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007079101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty