Provider Demographics
NPI:1851117014
Name:INNER HEALING CHARLESTON LLC
Entity type:Organization
Organization Name:INNER HEALING CHARLESTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:COVERDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-685-4007
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:FOLLY BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29439-0689
Mailing Address - Country:US
Mailing Address - Phone:919-599-9318
Mailing Address - Fax:
Practice Address - Street 1:1316 RUTLEDGE AVE STE 103
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-3050
Practice Address - Country:US
Practice Address - Phone:919-599-9318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty