Healthcare Provider Details

I. General information

NPI: 1528719432
Provider Name (Legal Business Name): INNER WELLNESS BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8211 VILLAGE HARBOR DR
CORNELIUS NC
28031-3706
US

IV. Provider business mailing address

991 GRACE JORDAN CT
DENVER NC
28037-8795
US

V. Phone/Fax

Practice location:
  • Phone: 984-315-0113
  • Fax:
Mailing address:
  • Phone: 704-763-0644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY WILKENS
Title or Position: OWNER
Credential: NP
Phone: 984-315-0113