Provider Demographics
NPI:1568741478
Name:INTEGRATED CONCEPTS FOR FAMILIES, INC.
Entity Type:Organization
Organization Name:INTEGRATED CONCEPTS FOR FAMILIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KISHA
Authorized Official - Middle Name:HASSANNA
Authorized Official - Last Name:WHITFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-703-8502
Mailing Address - Street 1:619 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-1142
Mailing Address - Country:US
Mailing Address - Phone:770-463-0202
Mailing Address - Fax:678-818-4619
Practice Address - Street 1:619 MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:GA
Practice Address - Zip Code:30268-1142
Practice Address - Country:US
Practice Address - Phone:770-703-8502
Practice Address - Fax:678-818-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
GA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003127292AMedicaid