Healthcare Provider Details

I. General information

NPI: 1508757428
Provider Name (Legal Business Name): INNER PEACE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15044 QUAIL LN
PAINTER VA
23420-2933
US

IV. Provider business mailing address

15044 QUAIL LN
PAINTER VA
23420-2933
US

V. Phone/Fax

Practice location:
  • Phone: 757-453-5211
  • Fax: 757-296-0209
Mailing address:
  • Phone: 757-453-5211
  • Fax: 757-296-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TIARA MONIQUE MCINTOSH
Title or Position: OWNER
Credential: ED.D, LPC
Phone: 757-453-5211