Provider Demographics
NPI:1982204673
Name:INTEGRATIVE CONSULTING SERVICES
Entity Type:Organization
Organization Name:INTEGRATIVE CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOCCARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-240-0022
Mailing Address - Street 1:7421 DOUGLAS BLVD STE N315
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1564
Mailing Address - Country:US
Mailing Address - Phone:770-240-0022
Mailing Address - Fax:
Practice Address - Street 1:7421 DOUGLAS BLVD STE N315
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1564
Practice Address - Country:US
Practice Address - Phone:770-240-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW007240OtherGA BOARD OF PROF COUNSELORS, SOCIAL WORKERS , MARRIAGE & FAMILY THERAPISTS