Provider Demographics
NPI:1497059935
Name:CENTER FOR INTEGRATIVE PSYCHOLOGY & WELLNESS INC
Entity Type:Organization
Organization Name:CENTER FOR INTEGRATIVE PSYCHOLOGY & WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:DECARVALHO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCETS, FNCCM
Authorized Official - Phone:707-253-9115
Mailing Address - Street 1:PO BOX 1932
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93232-1932
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1040 MAIN ST
Practice Address - Street 2:#305
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2654
Practice Address - Country:US
Practice Address - Phone:559-253-9115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-24
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20053103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1366480915Medicaid