Provider Demographics
NPI:1104505262
Name:INNER COMPASS COUNSELING, LLC
Entity type:Organization
Organization Name:INNER COMPASS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, ACS
Authorized Official - Phone:856-846-6408
Mailing Address - Street 1:19 PINE RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8155
Mailing Address - Country:US
Mailing Address - Phone:609-947-2482
Mailing Address - Fax:
Practice Address - Street 1:105 EVESBORO-MEDFORD RD
Practice Address - Street 2:SUITE M, MINDFUL THERAPY CENTER BUILDING
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-846-6408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)