Provider Demographics
NPI:1760853410
Name:INSIDE OUT COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:INSIDE OUT COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCAS
Authorized Official - Phone:910-754-7377
Mailing Address - Street 1:PO BOX 2352
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28459-2352
Mailing Address - Country:US
Mailing Address - Phone:910-754-7377
Mailing Address - Fax:910-754-7378
Practice Address - Street 1:632 VILLAGE RD SW STE 2
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-3434
Practice Address - Country:US
Practice Address - Phone:910-754-7377
Practice Address - Fax:910-754-7378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10093101YM0800X
NCLPC 10093251S00000X
NCLCAS 3399251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health