MEDICARE: INCITE & INSPIRE COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1245886712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INCITE & INSPIRE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	4741 GARDENIA TRCE
Second Line	:
City	:	MOUNT OLIVE
State	:	AL
Zip	:	35117-3461
Country	:	US
Telephone Number	:	205-602-9335
Fax Number	:

Provider Business Practice Location Address
First Line	:	4741 GARDENIA TRCE
Second Line	:
City	:	MOUNT OLIVE
State	:	AL
Zip	:	35117-3461
Country	:	US
Telephone Number	:	205-602-9335
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LISA SHEA MILLER
Credential	:	MA, LPC
Telephone Number	:	205-602-9335

Provider Enumeration Date	:	08/12/2019
Last Update Date	:	08/12/2019

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