Healthcare Provider Details

I. General information

NPI: 1790698066
Provider Name (Legal Business Name): INNER SOL WELLNESS CO., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16948 PARK PLACE ST APT 4
EAGLE RIVER AK
99577-7883
US

IV. Provider business mailing address

16948 PARK PLACE ST APT 4
EAGLE RIVER AK
99577-7883
US

V. Phone/Fax

Practice location:
  • Phone: 208-270-4257
  • Fax:
Mailing address:
  • Phone: 208-270-4257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CARLIE JARAMILLO
Title or Position: THERAPIST
Credential: LCSW
Phone: 208-270-4257