Provider Demographics
NPI:1396376232
Name:INTEGRATIVE COUNSELING OF GEORGIA,LLC
Entity Type:Organization
Organization Name:INTEGRATIVE COUNSELING OF GEORGIA,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZULAIKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:470-207-2434
Mailing Address - Street 1:7000 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:BUILDING 6, SUITE 302
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-2532
Mailing Address - Country:US
Mailing Address - Phone:470-207-2434
Mailing Address - Fax:
Practice Address - Street 1:7000 PEACHTREE DUNWOODY RD STE 200
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-1655
Practice Address - Country:US
Practice Address - Phone:678-949-6209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty