Provider Demographics
NPI:1083812481
Name:INNOVATIVE THERAPY AND CONSULTING, INC
Entity Type:Organization
Organization Name:INNOVATIVE THERAPY AND CONSULTING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LPC
Authorized Official - Phone:919-554-1231
Mailing Address - Street 1:833 WAKE FOREST BUSINESS PARK
Mailing Address - Street 2:SUITE G
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-7184
Mailing Address - Country:US
Mailing Address - Phone:919-554-1231
Mailing Address - Fax:919-554-2406
Practice Address - Street 1:833 WAKE FOREST BUSINESS PARK
Practice Address - Street 2:SUITE G
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-7184
Practice Address - Country:US
Practice Address - Phone:919-554-1231
Practice Address - Fax:919-554-2406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5457101YP2500X
NCC0045531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty