Healthcare Provider Details

I. General information

NPI: 1457275943
Provider Name (Legal Business Name): INTEGRATIVE PSYCHODYNAMICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 OLD PLANTATION DR
LYNCHBURG VA
24502-6963
US

IV. Provider business mailing address

3823 MOORMAN DR
LYNCHBURG VA
24501-3133
US

V. Phone/Fax

Practice location:
  • Phone: 434-515-0423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: AUSTIN NELSON
Title or Position: FOUNDER
Credential:
Phone: 434-515-0423