Healthcare Provider Details

I. General information

NPI: 1225627599
Provider Name (Legal Business Name): TRUE INTEGRATIVE HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 PEACHTREE ST NE STE 1957
ATLANTA GA
30309-3574
US

IV. Provider business mailing address

4062 PEACHTREE RD NE STE A-536
BROOKHAVEN GA
30319-3021
US

V. Phone/Fax

Practice location:
  • Phone: 678-322-8138
  • Fax: 470-468-0134
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIELLE IBELEMA
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 678-322-8138