Provider Demographics
NPI:1083142947
Name:INTEGRATIVE CAP HEALTH PRACTICES
Entity Type:Organization
Organization Name:INTEGRATIVE CAP HEALTH PRACTICES
Other - Org Name:ESSENCE IN NUTRITIION CONSULTANTS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROVIDER/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONIE
Authorized Official - Middle Name:V
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-259-2206
Mailing Address - Street 1:230 CARRIAGE STATION CIR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4655
Mailing Address - Country:US
Mailing Address - Phone:404-259-2206
Mailing Address - Fax:
Practice Address - Street 1:770 OLD ROSWELL PL STE G400
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-8635
Practice Address - Country:US
Practice Address - Phone:470-282-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12635154101YP1600X, 133NN1002X, 171000000X, 174H00000X, 175F00000X, 175T00000X, 261QC1500X, 261QC1800X, 261QH0100X, 261QM1100X, 261QP0905X, 261QP2300X, 405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard OutpatientGroup - Single Specialty
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or LocalGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty