Healthcare Provider Details

I. General information

NPI: 1679264196
Provider Name (Legal Business Name): INNER HEALING AND GROWTH WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 NYE AVE
ACUSHNET MA
02743-2750
US

IV. Provider business mailing address

32 NYE AVE
ACUSHNET MA
02743-2750
US

V. Phone/Fax

Practice location:
  • Phone: 617-943-0409
  • Fax:
Mailing address:
  • Phone: 617-943-0409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. GEORGE PRESTON HAYWOOD
Title or Position: OWNER
Credential: LICSW
Phone: 617-943-0409