Provider Demographics
NPI:1669923330
Name:INNER WELLNESS MENTAL HEALTH COUNSELING
Entity type:Organization
Organization Name:INNER WELLNESS MENTAL HEALTH COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAEMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:718-635-0595
Mailing Address - Street 1:7405 METROPOLITAN AVE
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2636
Mailing Address - Country:US
Mailing Address - Phone:718-635-0595
Mailing Address - Fax:
Practice Address - Street 1:7405 METROPOLITAN AVE
Practice Address - Street 2:SUITE 2F
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2636
Practice Address - Country:US
Practice Address - Phone:718-635-0595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005489-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty