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General NPI Number Information
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NPI Number | 1083142947
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE CAP HEALTH PRACTICES
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Dates
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Enumeration Date | 05/23/2017
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Last Update Date | 05/23/2017
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Provider Practice Location Address
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Address Line | 770 OLD ROSWELL PL STE G400
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City | ROSWELL
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State | GA
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Zip | 30076-8635
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Country | US
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Telephone | 470-282-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 230 CARRIAGE STATION CIR
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City | ROSWELL
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State | GA
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Zip | 30075-4655
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Country | US
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Telephone | 404-259-2206
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Fax |
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Authorized Official
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Title or Position | PROVIDER/ OWNER
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Name | DR. LEONIE V HARRIS
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Credential | P.H.D
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Telephone | 404-259-2206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 12635154
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 12635154
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 12635154
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 12635154
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | 12635154
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number | 12635154
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License Number State | TX
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Taxonomy #7
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 12635154
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License Number State | TX
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Taxonomy #8
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Taxonomy Code | 261QM1100X
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Taxonomy Name | Military/U.S. Coast Guard Outpatient Clinic/Center
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License Number | 12635154
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License Number State | TX
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Taxonomy #9
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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License Number | 12635154
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License Number State | TX
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Taxonomy #10
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 12635154
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License Number State | TX
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Taxonomy #11
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | 12635154
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License Number State | TX
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Taxonomy #12
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 12635154
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License Number State | TX
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Taxonomy #13
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 12635154
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License Number State | TX
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