Provider Demographics
NPI:1457769739
Name:INTEGRITY COUNSELING AND PERSONAL DEVELOPMENT LLC
Entity Type:Organization
Organization Name:INTEGRITY COUNSELING AND PERSONAL DEVELOPMENT LLC
Other - Org Name:CHRISTINE DALTON MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:706-387-0573
Mailing Address - Street 1:83 ATHENS ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-1401
Mailing Address - Country:US
Mailing Address - Phone:706-387-0573
Mailing Address - Fax:706-387-0573
Practice Address - Street 1:83 ATHENS ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-1401
Practice Address - Country:US
Practice Address - Phone:706-387-0573
Practice Address - Fax:706-387-0573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0040241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty