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General NPI Number Information
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NPI Number | 1497291942
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Entity Type | Organization
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Legal Business Name | INTEGRATED COUNSELING, INC.
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 4347 MUNDY MILL RD STE A2
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City | OAKWOOD
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State | GA
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Zip | 30566-2560
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Country | US
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Telephone | 770-540-8149
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Fax | 678-343-9490
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Provider Business Mailing Address
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Address Line | 4347 MUNDY MILL RD STE A2
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City | OAKWOOD
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State | GA
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Zip | 30566-2560
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Country | US
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Telephone | 770-540-8149
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Fax | 678-343-9490
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | PATT P SHIPP
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Credential | LPC MAC
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Telephone | 770-540-8149
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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 | LPC004304
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License Number State | GA
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