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General NPI Number Information
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NPI Number | 1174180822
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Entity Type | Organization
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Legal Business Name | KRUEGER INTEGRATIVE CARE, LLC
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Dates
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Enumeration Date | 05/28/2019
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Last Update Date | 05/28/2019
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Provider Practice Location Address
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Address Line | 4893 PRINCE WILLIAM PKWY
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City | WOODBRIDGE
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State | VA
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Zip | 22192-5403
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Country | US
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Telephone | 850-565-9710
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Fax |
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Provider Business Mailing Address
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Address Line | 4467 NEW MARKET RD
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City | NICEVILLE
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State | FL
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Zip | 32578-4915
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Country | US
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Telephone | 619-865-9399
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Fax |
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Authorized Official
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Title or Position | LICENCED PSYCHOLOGIST, DIRECTOR
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Name | DR. TONICE KRUEGER
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Credential | LCP
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Telephone | 619-865-9399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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