Provider Demographics
NPI:1740617695
Name:INTEGRAL COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:INTEGRAL COUNSELING SERVICES, PLLC
Other - Org Name:MIRIAM LIEBERMAN, MA, LPCS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER AND CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCS
Authorized Official - Phone:919-304-5754
Mailing Address - Street 1:1920 WESTERN TRL
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-5005
Mailing Address - Country:US
Mailing Address - Phone:919-304-5754
Mailing Address - Fax:
Practice Address - Street 1:1920 WESTERN TRL
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-5005
Practice Address - Country:US
Practice Address - Phone:919-304-5754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-07
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS3203101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102891Medicaid