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Organization
INNER PEACE COMMUNITY SUPPORT SERVICES LLC
Active
Organization
INNER PEACE COMMUNITY SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARRELL TENNIE (MANAGING DIRECTOR)
(919) 217-0933
Entity
Organization
Contact information
Practice address
3005 VILLAGE PARK DR STE 204, KNIGHTDALE, NC 27545-7993
(919) 944-3130
(919) 944-3131
Mailing address
3005 VILLAGE PARK DR STE 204, KNIGHTDALE, NC 27545-7993
(919) 944-3130
(919) 944-3131
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
9742
SC
1041C0700X
Clinical Social Worker
Primary
C006312
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6008780
—
NC
05
—
GP6439
—
SC
Enumeration date
08/19/2011
Last updated
03/16/2017
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