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General NPI Number Information
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NPI Number | 1649522806
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Entity Type | Organization
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Legal Business Name | INTEGRATED THERAPEUTIC SOLUTIONS, LLC
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Dates
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Enumeration Date | 10/11/2012
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 2450 ATLANTA HWY UNIT 1403
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City | CUMMING
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State | GA
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Zip | 30040-8099
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Country | US
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Telephone | 678-752-2336
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 ATLANTA HWY UNIT 1403
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City | CUMMING
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State | GA
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Zip | 30040-8099
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Country | US
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Telephone | 678-752-2336
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ANNA MORIARTY
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Credential | MPS, LPC, LMHC
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Telephone | 678-752-2336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC005279
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License Number State | GA
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