Provider Demographics
NPI:1437880556
Name:INTEGRATIVE THERAPEUTIC SOLUTIONS, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE THERAPEUTIC SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD, LCPC, CCTP-II
Authorized Official - Phone:202-441-7989
Mailing Address - Street 1:3200 CRAIN HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4843
Mailing Address - Country:US
Mailing Address - Phone:240-448-2475
Mailing Address - Fax:240-448-2335
Practice Address - Street 1:3200 CRAIN HWY STE 205
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4843
Practice Address - Country:US
Practice Address - Phone:240-448-2475
Practice Address - Fax:240-448-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-20
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD891005700Medicaid