Provider Demographics
NPI:1821230426
Name:INTEGRATIVE WELLNESS - BAERTA CLARE GRAFF
Entity Type:Organization
Organization Name:INTEGRATIVE WELLNESS - BAERTA CLARE GRAFF
Other - Org Name:INTEGRATIVE THERAPIES / CLARE GRAVES LEVIN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BAERTA
Authorized Official - Middle Name:CLARE
Authorized Official - Last Name:GRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, BSED, NCTMB
Authorized Official - Phone:864-506-2345
Mailing Address - Street 1:517 EATON ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL
Mailing Address - State:SC
Mailing Address - Zip Code:29630-9112
Mailing Address - Country:US
Mailing Address - Phone:864-506-2345
Mailing Address - Fax:
Practice Address - Street 1:517 EATON STREET
Practice Address - Street 2:
Practice Address - City:CENTRAL
Practice Address - State:SC
Practice Address - Zip Code:29630-9112
Practice Address - Country:US
Practice Address - Phone:864-506-2345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1796225700000X
GAMA002912225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty