Provider Demographics
NPI:1679264196
Name:INNER HEALING AND GROWTH WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:INNER HEALING AND GROWTH WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:HAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-943-0409
Mailing Address - Street 1:32 NYE AVE
Mailing Address - Street 2:
Mailing Address - City:ACUSHNET
Mailing Address - State:MA
Mailing Address - Zip Code:02743-2750
Mailing Address - Country:US
Mailing Address - Phone:617-943-0409
Mailing Address - Fax:
Practice Address - Street 1:32 NYE AVE
Practice Address - Street 2:
Practice Address - City:ACUSHNET
Practice Address - State:MA
Practice Address - Zip Code:02743-2750
Practice Address - Country:US
Practice Address - Phone:617-943-0409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty