Healthcare Provider Details

I. General information

NPI: 1639781354
Provider Name (Legal Business Name): INNER KNOWING CLINICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/24/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 BROWN RD
DURHAM ME
04222-5213
US

IV. Provider business mailing address

PMB BOX 354 190 US ROUTE 1
FALMOUTH ME
04105
US

V. Phone/Fax

Practice location:
  • Phone: 207-707-5129
  • Fax:
Mailing address:
  • Phone: 207-707-5129
  • 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: CAROL DESPRES
Title or Position: CEO/OWNER
Credential: LCSW
Phone: 207-707-5129