Provider Demographics
NPI:1528723152
Name:INNER SANCTUARY COUNSELING LLC
Entity type:Organization
Organization Name:INNER SANCTUARY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUGILE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT/ RPT
Authorized Official - Phone:808-909-2115
Mailing Address - Street 1:11180 HWY 51 S
Mailing Address - Street 2:STE 7 PMB 1032
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004
Mailing Address - Country:US
Mailing Address - Phone:808-909-2111
Mailing Address - Fax:747-666-0942
Practice Address - Street 1:11180 HWY 51 S
Practice Address - Street 2:STE 7 PMB 1032
Practice Address - City:ATOKA
Practice Address - State:TN
Practice Address - Zip Code:38004
Practice Address - Country:US
Practice Address - Phone:808-909-2111
Practice Address - Fax:747-666-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)