Healthcare Provider Details

I. General information

NPI: 1609132901
Provider Name (Legal Business Name): INNER PEACE PSYCHOLOGICAL SERVICES AND INTEGRATIVE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 TOWERVIEW CT
CARY NC
27513-3595
US

IV. Provider business mailing address

102 TOWERVIEW CT
CARY NC
27513-3595
US

V. Phone/Fax

Practice location:
  • Phone: 919-594-6510
  • Fax: 919-666-0039
Mailing address:
  • Phone: 919-594-6510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7877
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2009-01396
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number195204
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number50-02016
License Number StateNC

VIII. Authorized Official

Name: MS. JENNIFER ALLYN SCHAAL
Title or Position: PRACTICE OWNER AND THERAPIST
Credential: LPC,NCC
Phone: 814-450-1608