Provider Demographics
NPI:1992178230
Name:INTEGRATED THERAPEUTIC SOLUTIONS, LLC
Entity Type:Organization
Organization Name:INTEGRATED THERAPEUTIC SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNALEIGHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MPS, LPC, LMHC, CPCS
Authorized Official - Phone:678-722-1031
Mailing Address - Street 1:2450 ATLANTA HWY
Mailing Address - Street 2:UNIT 1403
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8099
Mailing Address - Country:US
Mailing Address - Phone:678-722-1031
Mailing Address - Fax:678-909-0441
Practice Address - Street 1:2450 ATLANTA HWY
Practice Address - Street 2:UNIT 1403
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8099
Practice Address - Country:US
Practice Address - Phone:678-722-1031
Practice Address - Fax:678-909-0441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8573101YM0800X
GA5279101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL966506735AMedicaid