Provider Demographics
NPI:1356052112
Name:INTEGRATIVE BRAIN HEALTH LLC
Entity type:Organization
Organization Name:INTEGRATIVE BRAIN HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC
Authorized Official - Phone:410-387-9823
Mailing Address - Street 1:1914 BEL AIR RD
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2724
Mailing Address - Country:US
Mailing Address - Phone:410-387-9823
Mailing Address - Fax:
Practice Address - Street 1:1914 BEL AIR RD
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2724
Practice Address - Country:US
Practice Address - Phone:410-387-9823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VICTORIA L. LITTLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty