MEDICARE: INTEGRITY COUNSELING AND CONSULTING SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C004849	NC

General Provider Information

NPI Number	:	1427289735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRITY COUNSELING AND CONSULTING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	1001 E WT HARRIS BLVD
Second Line	:	SUITE P107
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-4104
Country	:	US
Telephone Number	:	704-947-7534
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 E WT HARRIS BLVD
Second Line	:	SUITE P107
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-4104
Country	:	US
Telephone Number	:	704-947-7534
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST/CEO
Name	:	LATONYA RAYETTE MOORE
Credential	:	LCSW
Telephone Number	:	704-947-7534

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	08/04/2009

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