Provider Demographics
NPI:1265170773
Name:IKULTIVATE COUNSELING AND CONSULTING. PLLC
Entity type:Organization
Organization Name:IKULTIVATE COUNSELING AND CONSULTING. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:228-261-9625
Mailing Address - Street 1:22623 WINTER MAPLE TRL
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-2075
Mailing Address - Country:US
Mailing Address - Phone:228-261-9625
Mailing Address - Fax:
Practice Address - Street 1:22623 WINTER MAPLE TRL
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-2075
Practice Address - Country:US
Practice Address - Phone:832-377-6203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty