NPIMap

Organization Active NPI

Inner Source Therapy, PLLC

Doing business as Inner Source Therapy

  • Mental Health Counselor
  • New Bern, NC
National Provider Identifier
1831867175
Registry record updated Sep 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
INNER SOURCE THERAPY, PLLC
Doing business as
Inner Source Therapy
Practice address
790 Cardinal Rd
New Bern, NC 28562-5202
Phone
(252) 658-0565
Fax
(252) 636-1100
NPI assigned
Sep 1, 2021
Last updated
Sep 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2021

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

Authorized official

Name
Ms. Deborah J Ashway, LCMHC, LCASNPI 1194134619
Title
Owner
Phone
(252) 658-0565

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

790 Cardinal Rd
New Bern, NC 28562-5202

Mailing address

261 Goose Creek Rd
New Bern, NC 28562-3667
Phone (252) 658-0565

Other names 1

  • Inner Source Therapy Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL secure.simplepractice.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240410001787 NC Part B Supplier - Clinic/Group Practice 1153771787 Receives reassigned benefits from 4 practitioners
Practice locations: New Bern, NC

National Provider Directory

National Provider Directory

Locations

3402 Trent Rd
New Bern, NC 28562
Phone (252) 571-6508

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1630454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630627200000",
    "number": "1831867175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "261 GOOSE CREEK RD",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285623667",
            "telephone_number": "252-658-0565",
            "fax_number": "252-643-9332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 CARDINAL RD",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285625202",
            "telephone_number": "252-658-0565",
            "fax_number": "252-636-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNER SOURCE THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-01",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A",
        "authorized_official_last_name": "ASHWAY",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-658-0565",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCMHC, LCAS"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "secure.simplepractice.com",
            "affiliation": "N",
            "endpointDescription": "HIPPA Compliant softward",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "notes",
            "address_1": "790 Cardinal Rd",
            "city": "New Bern",
            "state": "NC",
            "country_code": "US",
            "postal_code": "285625202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Inner Source Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Bern, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2021; 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.