Provider Demographics
NPI:1811132509
Name:INNER PEACE LIFE DEVELOPMENT CENTER
Entity type:Organization
Organization Name:INNER PEACE LIFE DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR/QMHP
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:910-474-6253
Mailing Address - Street 1:1618 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-5430
Mailing Address - Country:US
Mailing Address - Phone:910-474-6253
Mailing Address - Fax:
Practice Address - Street 1:1618 W 5TH ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-5430
Practice Address - Country:US
Practice Address - Phone:910-474-6253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-078-215251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health