Provider Demographics
NPI:1831867175
Name:INNER SOURCE THERAPY, PLLC
Entity type:Organization
Organization Name:INNER SOURCE THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:ASHWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC, LCAS
Authorized Official - Phone:252-658-0565
Mailing Address - Street 1:261 GOOSE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-3667
Mailing Address - Country:US
Mailing Address - Phone:252-658-0565
Mailing Address - Fax:252-643-9332
Practice Address - Street 1:790 CARDINAL RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5202
Practice Address - Country:US
Practice Address - Phone:252-658-0565
Practice Address - Fax:252-636-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1194134619OtherMENTAL HEALTH THERAPISTS, LCMHC, LCAS
NC1750886826OtherMENTAL HEALTH THERAPISTS, LCMHC, LCAS
NC1770780025OtherMENTAL HEALTH THERAPISTS, LCMHC