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General NPI Number Information
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NPI Number | 1053671321
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Entity Type | Organization
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Legal Business Name | INTEGRATED WELLNESS COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 05/21/2012
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Provider Practice Location Address
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Address Line | 195 W PIKE ST SUITE 203
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4966
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Country | US
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Telephone | 678-318-1994
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Fax | 678-377-6080
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Provider Business Mailing Address
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Address Line | PO BOX 1359
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-1359
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Country | US
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Telephone | 678-318-1994
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Fax | 678-377-6080
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Authorized Official
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Title or Position | OWNER
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Name | MS. DEVONA M STALNAKER
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Credential | LPC
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Telephone | 678-318-1994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC004683
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License Number State | GA
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