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General NPI Number Information
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NPI Number | 1669079729
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Entity Type | Organization
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Legal Business Name | INNER RESOURCES COUNSELING, PC
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 10/02/2020
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Provider Practice Location Address
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Address Line | 74 ATLANTIC AVE
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City | MARBLEHEAD
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State | MA
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Zip | 01945-3066
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Country | US
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Telephone | 617-501-1083
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Fax |
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Provider Business Mailing Address
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Address Line | 23 BROOKLINE ST
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City | LYNN
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State | MA
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Zip | 01902-1807
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Country | US
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Telephone | 617-501-1083
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK ACHILLES NICKOLAS
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Credential | PHD, LMHC
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Telephone | 617-501-1083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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