Provider Demographics
NPI:1649159047
Name:INNER MOSAIC COUNSELING PLLC
Entity type:Organization
Organization Name:INNER MOSAIC COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER AND MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:INFINITI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-457-2207
Mailing Address - Street 1:301 S MCDOWELL ST STE 125-1763
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2623
Mailing Address - Country:US
Mailing Address - Phone:980-457-2207
Mailing Address - Fax:
Practice Address - Street 1:301 S MCDOWELL ST STE 125-1763
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2623
Practice Address - Country:US
Practice Address - Phone:980-457-2207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty