Healthcare Provider Details

I. General information

NPI: 1396303772
Provider Name (Legal Business Name): INTEGRATED THERAPEUTIC SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 GRANBY ST STE 251
NORFOLK VA
23510-2503
US

IV. Provider business mailing address

PO BOX 61939
VIRGINIA BEACH VA
23466-1939
US

V. Phone/Fax

Practice location:
  • Phone: 757-477-9416
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. NORRIS SHERMON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 757-477-9416