Provider Demographics
NPI:1255732897
Name:LOVELACE INTEGRATIVE THERAPIES, LLC
Entity type:Organization
Organization Name:LOVELACE INTEGRATIVE THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHANEIKA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOVELACE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-418-8707
Mailing Address - Street 1:438 S MAIN ST
Mailing Address - Street 2:2B
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3920
Mailing Address - Country:US
Mailing Address - Phone:443-418-8707
Mailing Address - Fax:
Practice Address - Street 1:438 S MAIN ST
Practice Address - Street 2:2B
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3920
Practice Address - Country:US
Practice Address - Phone:443-418-8707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3595101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty