Provider Demographics
NPI:1518565928
Name:FAMILY AND INDIVIDUAL THERAPEUTIC HEALING LLC
Entity Type:Organization
Organization Name:FAMILY AND INDIVIDUAL THERAPEUTIC HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GIOVANNELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:330-280-0716
Mailing Address - Street 1:208 ASHEWICKE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7059
Mailing Address - Country:US
Mailing Address - Phone:330-280-0716
Mailing Address - Fax:
Practice Address - Street 1:300 LONG POINTE LN STE 220-B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7543
Practice Address - Country:US
Practice Address - Phone:803-500-5086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty