Provider Demographics
NPI:1376258558
Name:YOUR INNER PEACE COUNSELING & WELLNESS
Entity Type:Organization
Organization Name:YOUR INNER PEACE COUNSELING & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:209-629-0572
Mailing Address - Street 1:PO BOX 78012
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-1312
Mailing Address - Country:US
Mailing Address - Phone:209-629-0572
Mailing Address - Fax:
Practice Address - Street 1:343 E MAIN ST STE 400
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-3057
Practice Address - Country:US
Practice Address - Phone:209-337-4870
Practice Address - Fax:209-625-1390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty