Provider Demographics
NPI:1225629587
Name:INTEGRATED COUNSELING AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:INTEGRATED COUNSELING AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KANDISS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:470-552-7005
Mailing Address - Street 1:2480 WINDY HILL RD SE STE 107
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8608
Mailing Address - Country:US
Mailing Address - Phone:470-552-7005
Mailing Address - Fax:
Practice Address - Street 1:2480 WINDY HILL RD SE STE 107
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8608
Practice Address - Country:US
Practice Address - Phone:470-552-7005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty