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General NPI Number Information
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NPI Number | 1497059935
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Entity Type | Organization
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Legal Business Name | CENTER FOR INTEGRATIVE PSYCHOLOGY & WELLNESS INC
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Dates
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Enumeration Date | 12/24/2010
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Last Update Date | 03/30/2011
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Provider Practice Location Address
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Address Line | 1040 MAIN ST #305
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City | NAPA
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State | CA
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Zip | 94559-2654
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Country | US
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Telephone | 559-253-9115
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1932
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City | HANFORD
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State | CA
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Zip | 93232-1932
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER AND PRESIDENT/CEO
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Name | DR. LORIE T DECARVALHO
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Credential | PH.D., BCETS, FNCCM
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Telephone | 707-253-9115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY20053
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License Number State | CA
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