| Organization Name: | INNER PEACE THERAPEUTIC SERVICES, LLC |
| NPI Number: | 1710303573 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JACQUELINE DALE GRANTLAND (OWNER) |
| Mailing Address: | 21855 Three Notch Rd Lexington Park |
| State: | MD US |
| Postal Code: | 206531564 |
| Phone Number: | 2407188460 |
| Fax Number: | 2407181906 |
| NPI Enumeration Date: | 03/17/2014 |
| NPI Last Update Date: | 03/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LC4189 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |