Provider Demographics
NPI:1407544786
Name:TRU-INTEGRITY WELLNESS & COUNSELING CENTER
Entity Type:Organization
Organization Name:TRU-INTEGRITY WELLNESS & COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LULA
Authorized Official - Middle Name:MOULTRIE
Authorized Official - Last Name:HEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWC
Authorized Official - Phone:443-449-7573
Mailing Address - Street 1:1900 E NORTHERN PKWY STE T7
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2120
Mailing Address - Country:US
Mailing Address - Phone:509-235-1120
Mailing Address - Fax:
Practice Address - Street 1:1900 E NORTHERN PKWY STE T7
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2120
Practice Address - Country:US
Practice Address - Phone:443-449-7573
Practice Address - Fax:443-449-7573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD045579200Medicaid