Provider Demographics
NPI:1467439661
Name:NORTH STATE CONSORTIUM FOR PSYCHOSOCIAL WELLNESS
Entity Type:Organization
Organization Name:NORTH STATE CONSORTIUM FOR PSYCHOSOCIAL WELLNESS
Other - Org Name:INNERWORK PSYCHOTHERAPY & COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TIG
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:919-924-0858
Mailing Address - Street 1:1419 CRAWFORD DAIRY RD
Mailing Address - Street 2:UNIT C
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-8521
Mailing Address - Country:US
Mailing Address - Phone:919-942-0858
Mailing Address - Fax:
Practice Address - Street 1:104 JONES FERRY RD
Practice Address - Street 2:UNIT J
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-2036
Practice Address - Country:US
Practice Address - Phone:919-942-0858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable