Provider Demographics
NPI:1063847549
Name:INTEGRATIVE BEHAVIORAL SUPPORTS INC.
Entity Type:Organization
Organization Name:INTEGRATIVE BEHAVIORAL SUPPORTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:RACHELLE
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC/FNP-BC
Authorized Official - Phone:202-785-1836
Mailing Address - Street 1:2001 MASSACHUSETTS AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-1011
Mailing Address - Country:US
Mailing Address - Phone:202-785-1836
Mailing Address - Fax:202-722-0169
Practice Address - Street 1:2001 MASSACHUSETTS AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1011
Practice Address - Country:US
Practice Address - Phone:202-785-1836
Practice Address - Fax:202-722-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1010245251S00000X
VA0024167884251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health