Organization Active NPI

Inner Peace Counseling Services, PLLC

  • Counseling Psychologist
  • Charlotte, NC
National Provider Identifier
1245465533
Registry record updated Jul 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
2409 Issued in NC
Legal business name
INNER PEACE COUNSELING SERVICES, PLLC
Practice address
1931 J N Pease PL
202
Charlotte, NC 28262-4544
Phone
(704) 717-2800
Fax
(707) 717-6200
NPI assigned
May 15, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Angela Hargrow, PH.D.
Title
Licensed Psychologist
Phone
(704) 717-2800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC1900X 2409 NC Primary

Addresses

Primary practice location

1931 J N Pease PL
202
Charlotte, NC 28262-4544

Mailing address

1931 J N Pease PL
202
Charlotte, NC 28262-4544
Phone (704) 717-2800

Other identifiers 1

IdentifierTypeStateIssuer
6000309MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110120001165 NC Part B Supplier - Clinic/Group Practice 4587843669 Receives reassigned benefits from 4 practitioners
Practice locations: Charlotte, NC

National Provider Directory

National Provider Directory

Locations

1931 J N Pease Pl
Ste 204
Charlotte, NC 28262
Phone (704) 549-3993

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248652800000",
    "number": "1245465533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1931 J N PEASE PL",
            "address_2": "202",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282624544",
            "telephone_number": "704-717-2800",
            "fax_number": "707-717-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1931 J N PEASE PL",
            "address_2": "202",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282624544",
            "telephone_number": "704-717-2800",
            "fax_number": "707-717-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNER PEACE COUNSELING SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-15",
        "last_updated": "2009-07-27",
        "status": "A",
        "authorized_official_last_name": "HARGROW",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "704-717-2800",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": "NC",
            "license": "2409",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6000309",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.