Provider Demographics
NPI:1043620321
Name:INNERSPACE COUNSELING, LLC
Entity type:Organization
Organization Name:INNERSPACE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AJITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-448-9282
Mailing Address - Street 1:2433 ROUTE 516
Mailing Address - Street 2:SUITE D
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1899
Mailing Address - Country:US
Mailing Address - Phone:732-332-8270
Mailing Address - Fax:732-862-1146
Practice Address - Street 1:2433 ROUTE 516
Practice Address - Street 2:SUITE D
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1899
Practice Address - Country:US
Practice Address - Phone:732-332-8270
Practice Address - Fax:732-862-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health