Healthcare Provider Details

I. General information

NPI: 1801487574
Provider Name (Legal Business Name): INSPIRED PEACE COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 WINTER GARDEN DR
VALPARAISO IN
46385-7140
US

IV. Provider business mailing address

3009 WINTER GARDEN DR
VALPARAISO IN
46385-7140
US

V. Phone/Fax

Practice location:
  • Phone: 219-508-5646
  • Fax:
Mailing address:
  • Phone: 219-508-5646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DOMINIQUE JACKSON
Title or Position: COO/ PSYCHOTHERAPIST
Credential: LCSW
Phone: 219-613-7872