Provider Demographics
NPI:1699381269
Name:INTEGRATIVE PSYCHOLOGICAL MEDICINE
Entity Type:Organization
Organization Name:INTEGRATIVE PSYCHOLOGICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ONORIODE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-676-4060
Mailing Address - Street 1:6335 POPLAR FOREST DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27358-9338
Mailing Address - Country:US
Mailing Address - Phone:336-676-4060
Mailing Address - Fax:949-561-4318
Practice Address - Street 1:600 GREEN VALLEY RD STE 304
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7722
Practice Address - Country:US
Practice Address - Phone:337-676-4060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-19
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty