Provider Demographics
NPI:1639781354
Name:INNER KNOWING CLINICAL THERAPY LLC
Entity Type:Organization
Organization Name:INNER KNOWING CLINICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:DESPRES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-707-5129
Mailing Address - Street 1:PMB BOX 354
Mailing Address - Street 2:190 US ROUTE 1
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105
Mailing Address - Country:US
Mailing Address - Phone:207-707-5129
Mailing Address - Fax:
Practice Address - Street 1:117 BROWN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:ME
Practice Address - Zip Code:04222-5213
Practice Address - Country:US
Practice Address - Phone:207-707-5129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty