Provider Demographics
NPI:1346691623
Name:INTEGRATIVE WELLNESS COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:INTEGRATIVE WELLNESS COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:BAHIYYA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMH-SHERE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-748-0123
Mailing Address - Street 1:931 MONROE DR NE
Mailing Address - Street 2:#A102-456
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1793
Mailing Address - Country:US
Mailing Address - Phone:678-748-0123
Mailing Address - Fax:404-393-5939
Practice Address - Street 1:204 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3328
Practice Address - Country:US
Practice Address - Phone:678-748-0213
Practice Address - Fax:404-393-5939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008882101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty