Provider Demographics
NPI:1275223950
Name:INNER EXCELLENCE BEHAVIORAL HEALTH SERVICES, PLLC
Entity Type:Organization
Organization Name:INNER EXCELLENCE BEHAVIORAL HEALTH SERVICES, PLLC
Other - Org Name:INNER EXCELLENCE BEHAVIORAL HEALTH PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:805-418-0456
Mailing Address - Street 1:1140 AMBERJACK CT
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-1019
Mailing Address - Country:US
Mailing Address - Phone:805-418-0456
Mailing Address - Fax:
Practice Address - Street 1:2407 GRACE AVE
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-4416
Practice Address - Country:US
Practice Address - Phone:805-418-0456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty