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General NPI Number Information
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NPI Number | 1104651124
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE TREATMENT SERVICES LLC
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 2329 SPRINGS RD NE
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City | HICKORY
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State | NC
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Zip | 28601-3067
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Country | US
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Telephone | 919-440-7215
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 COTSWOLD TER UNIT 3K
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City | GREENSBORO
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State | NC
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Zip | 27410-8905
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Country | US
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Telephone | 919-440-7215
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | NATHANIEL PETERKIN
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Credential |
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Telephone | 336-292-2923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State |
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