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General NPI Number Information
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NPI Number | 1639778905
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Entity Type | Organization
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Legal Business Name | INTENTIONAL GROWTH BEHAVIORAL HEALTH SERVICES, PLLC
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Dates
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Enumeration Date | 10/19/2020
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Last Update Date | 12/31/2022
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Provider Practice Location Address
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Address Line | 12925 HIGHWAY 601 STE 500
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City | MIDLAND
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State | NC
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Zip | 28107-9537
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Country | US
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Telephone | 252-287-8620
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Fax |
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Provider Business Mailing Address
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Address Line | 776 ALEXANDER COMMONS DR
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City | MONROE
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State | NC
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Zip | 28112-7650
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Country | US
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Telephone | 252-287-8620
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Fax |
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Authorized Official
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Title or Position | ORGANIZER/ OWNER
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Name | ASHLEY MARIE ADAM
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Credential | LCSW
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Telephone | 252-287-8620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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