Provider Demographics
NPI:1497291942
Name:INTEGRATED COUNSELING, INC.
Entity Type:Organization
Organization Name:INTEGRATED COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATT
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHIPP
Authorized Official - Suffix:
Authorized Official - Credentials:LPC MAC
Authorized Official - Phone:770-540-8149
Mailing Address - Street 1:4347 MUNDY MILL RD STE A2
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-2560
Mailing Address - Country:US
Mailing Address - Phone:770-540-8149
Mailing Address - Fax:678-343-9490
Practice Address - Street 1:4347 MUNDY MILL RD STE A2
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2560
Practice Address - Country:US
Practice Address - Phone:770-540-8149
Practice Address - Fax:678-343-9490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004304261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)