Provider Demographics
NPI:1518083880
Name:PEACEFUL PERSONAL GROWTH PROGRAM INC.
Entity Type:Organization
Organization Name:PEACEFUL PERSONAL GROWTH PROGRAM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:828-442-5015
Mailing Address - Street 1:PO BOX 2855
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-0228
Mailing Address - Country:US
Mailing Address - Phone:828-442-5015
Mailing Address - Fax:828-665-4354
Practice Address - Street 1:436 STATE ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-4029
Practice Address - Country:US
Practice Address - Phone:828-442-5015
Practice Address - Fax:828-665-4354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPC0009101YA0400X, 101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005093Medicaid
NC011E4OtherBCBSNC GROUP PROVIDER NUM