Provider Demographics
NPI:1518295203
Name:INTEGRATIVE COMMUNTIY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE COMMUNTIY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:336-330-0023
Mailing Address - Street 1:PO BOX 849
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-0849
Mailing Address - Country:US
Mailing Address - Phone:336-330-0023
Mailing Address - Fax:336-330-0028
Practice Address - Street 1:220 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-0849
Practice Address - Country:US
Practice Address - Phone:336-330-0023
Practice Address - Fax:336-330-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X101YA0400X
NC251S00000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty