Healthcare Provider Details

I. General information

NPI: 1689323511
Provider Name (Legal Business Name): INTEGRATIVE BEHAVIORAL HEALTH & HEALING PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2022
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E FISHER AVE
GREENSBORO NC
27401-2034
US

IV. Provider business mailing address

124 E FISHER AVE
GREENSBORO NC
27401-2034
US

V. Phone/Fax

Practice location:
  • Phone: 984-288-0880
  • Fax: 984-217-1701
Mailing address:
  • Phone: 984-288-0880
  • Fax: 984-217-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAREN DAY NICHOLSON
Title or Position: PROVIDER/OWNER
Credential: MSN, NP
Phone: 984-288-0880