Healthcare Provider Details

I. General information

NPI: 1922857580
Provider Name (Legal Business Name): INTEGRATED INSTITUTE OF HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 GA-124
HOSCHTON GA
30548
US

IV. Provider business mailing address

1864 SOQUE CIR
JEFFERSON GA
30549-2307
US

V. Phone/Fax

Practice location:
  • Phone: 404-960-9629
  • Fax:
Mailing address:
  • Phone: 404-960-9629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE KATE GULLEY
Title or Position: SR. VP CO-FOUNDER
Credential:
Phone: 404-960-9629