Provider Demographics
NPI:1376269100
Name:INNER HEALING AND PEACE PLLC
Entity Type:Organization
Organization Name:INNER HEALING AND PEACE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:SINK
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC, CCTP
Authorized Official - Phone:336-970-1697
Mailing Address - Street 1:236 REEDY CREEK SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-9760
Mailing Address - Country:US
Mailing Address - Phone:336-970-1697
Mailing Address - Fax:
Practice Address - Street 1:2910 BRIARCLIFFE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3176
Practice Address - Country:US
Practice Address - Phone:336-970-1697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1053875021OtherOWNER NPI NUMBER