Provider Demographics
NPI:1881313823
Name:INNER SELF HEALING CENTER, LLC
Entity type:Organization
Organization Name:INNER SELF HEALING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-818-8182
Mailing Address - Street 1:12 S SUMMIT AVE STE 100-A6
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2089
Mailing Address - Country:US
Mailing Address - Phone:301-818-8182
Mailing Address - Fax:
Practice Address - Street 1:12 S SUMMIT AVE STE 100-A06
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2089
Practice Address - Country:US
Practice Address - Phone:301-424-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty