Provider Demographics
NPI:1699090662
Name:INNER STRENGTH COUNSELING SERVICES
Entity type:Organization
Organization Name:INNER STRENGTH COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:REEVES
Authorized Official - Last Name:CODRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:704-566-3633
Mailing Address - Street 1:3139 AMITY CT
Mailing Address - Street 2:200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-4934
Mailing Address - Country:US
Mailing Address - Phone:704-566-3633
Mailing Address - Fax:704-288-4391
Practice Address - Street 1:3139 AMITY CT
Practice Address - Street 2:200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-4934
Practice Address - Country:US
Practice Address - Phone:704-566-3633
Practice Address - Fax:704-288-4391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-02
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC006232101YM0800X, 101YP2500X, 102L00000X, 1041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2853448BOtherMEDICARE PTAN
NC6008065Medicaid