Provider Demographics
NPI:1679103097
Name:INNER PEACES COUNSELING AND CONSULTING LLC
Entity type:Organization
Organization Name:INNER PEACES COUNSELING AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANANCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-788-7703
Mailing Address - Street 1:6127 S UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-5894
Mailing Address - Country:US
Mailing Address - Phone:773-494-9457
Mailing Address - Fax:
Practice Address - Street 1:73 W MONROE ST STE 228
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-4955
Practice Address - Country:US
Practice Address - Phone:773-413-8054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)