Provider Demographics
NPI:1780455410
Name:INNER REST COUNSELING, LLC
Entity type:Organization
Organization Name:INNER REST COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCMHC, LCAS
Authorized Official - Phone:854-245-0184
Mailing Address - Street 1:11 PARKLANDS DR UNIT 1737
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-5193
Mailing Address - Country:US
Mailing Address - Phone:980-277-4404
Mailing Address - Fax:
Practice Address - Street 1:1 PROFESSIONAL DR STE 8
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-1104
Practice Address - Country:US
Practice Address - Phone:854-245-0184
Practice Address - Fax:980-303-2682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty