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General NPI Number Information
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NPI Number | 1326674003
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE SOCIAL SERVICES LLC
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Dates
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Enumeration Date | 03/13/2020
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Last Update Date | 03/13/2020
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Provider Practice Location Address
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Address Line | 2301 PARK AVE STE 205
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City | ORANGE PARK
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State | FL
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Zip | 32073-5558
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Country | US
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Telephone | 904-592-7298
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Fax |
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Provider Business Mailing Address
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Address Line | 1085 ATLANTIC BLVD APT 13
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City | ATLANTIC BEACH
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State | FL
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Zip | 32233-3341
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Country | US
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Telephone | 904-834-1341
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Fax |
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Authorized Official
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Title or Position | IMFT
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Name | THUYDY NGUYEN
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Credential | MS
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Telephone | 904-834-1341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 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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