Healthcare Provider Details

I. General information

NPI: 1487882924
Provider Name (Legal Business Name): INNER PEACE BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 03/06/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 12TH AVE S STE B
NORTH MYRTLE BEACH SC
29582-3765
US

IV. Provider business mailing address

801 12TH AVE S SUITE B
NORTH MYRTLE BEACH SC
29582-3765
US

V. Phone/Fax

Practice location:
  • Phone: 843-663-0828
  • Fax: 843-663-0828
Mailing address:
  • Phone: 843-663-0828
  • Fax: 843-492-6766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BEVIN NIXON
Title or Position: THERAPIST & OWNER
Credential: LCSW
Phone: 609-803-3077