Provider Demographics
NPI:1891061834
Name:INTEGRATIVE SERVICES & SOLUTIONS, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE SERVICES & SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ICADC
Authorized Official - Phone:404-759-1396
Mailing Address - Street 1:1203 ALEXANDER CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1243
Mailing Address - Country:US
Mailing Address - Phone:404-759-1396
Mailing Address - Fax:
Practice Address - Street 1:1203 ALEXANDER CIR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1243
Practice Address - Country:US
Practice Address - Phone:404-759-1396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health