Provider Demographics
NPI:1912397928
Name:INTEGRATED TRAUMA THERAPIES LLC
Entity Type:Organization
Organization Name:INTEGRATED TRAUMA THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-462-1313
Mailing Address - Street 1:PO BOX 23794
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29224-3794
Mailing Address - Country:US
Mailing Address - Phone:803-462-1313
Mailing Address - Fax:
Practice Address - Street 1:9711 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:SC
Practice Address - Zip Code:29061-9148
Practice Address - Country:US
Practice Address - Phone:803-462-1313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 1041C0700X, 106H00000X
SC1007103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty