Provider Demographics
NPI:1518682558
Name:SG INTEGRATIVE PSYCHIATRY AND WELLNESS PLLC
Entity Type:Organization
Organization Name:SG INTEGRATIVE PSYCHIATRY AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:NKEM
Authorized Official - Middle Name:O
Authorized Official - Last Name:NKWONTA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:919-214-2390
Mailing Address - Street 1:PO BOX 14123
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27709-4123
Mailing Address - Country:US
Mailing Address - Phone:509-218-2210
Mailing Address - Fax:
Practice Address - Street 1:100 N HOWARD ST STE W
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0508
Practice Address - Country:US
Practice Address - Phone:509-218-2210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty