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General NPI Number Information
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NPI Number | 1831764968
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE VIRTUAL MENTAL HEALTH
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 285 W WIEUCA RD NE STE 5441
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City | ATLANTA
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State | GA
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Zip | 30342-3321
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Country | US
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Telephone | 678-559-9510
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Fax |
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Provider Business Mailing Address
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Address Line | 90 BELLVIEW RDG
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City | SHARPSBURG
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State | GA
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Zip | 30277-1556
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Country | US
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Telephone | 678-559-9510
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Fax |
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Authorized Official
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Title or Position | LPC
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Name | PAMELA TREMBLAY
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Credential |
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Telephone | 770-339-7667
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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 |
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License Number State |
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