Provider Demographics
NPI:1104194687
Name:INTEGRATED WELLNESS OUTREACH, LLC
Entity Type:Organization
Organization Name:INTEGRATED WELLNESS OUTREACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RASHIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-400-2053
Mailing Address - Street 1:544 MEDLOCK RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1515
Mailing Address - Country:US
Mailing Address - Phone:678-400-2053
Mailing Address - Fax:
Practice Address - Street 1:544 MEDLOCK RD
Practice Address - Street 2:SUITE 106
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1515
Practice Address - Country:US
Practice Address - Phone:678-400-2053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006469101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty