Provider Demographics
NPI:1639449531
Name:INTEGRATIVE COUNSEL PLLC
Entity Type:Organization
Organization Name:INTEGRATIVE COUNSEL PLLC
Other - Org Name:E STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRACTICIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAYNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LMHC, REAT
Authorized Official - Phone:727-342-0054
Mailing Address - Street 1:2217 BREVARD RD NE
Mailing Address - Street 2:ST. PETERSBURG
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-3541
Mailing Address - Country:US
Mailing Address - Phone:727-342-0054
Mailing Address - Fax:
Practice Address - Street 1:11 9TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1616
Practice Address - Country:US
Practice Address - Phone:727-342-0054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11004251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health