Provider Demographics
NPI:1932589587
Name:INTEGRATIVE RECOVERY THERAPIES, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE RECOVERY THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MILTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:252-202-1848
Mailing Address - Street 1:1010 FRISCOVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:ARABI
Mailing Address - State:LA
Mailing Address - Zip Code:70032-1210
Mailing Address - Country:US
Mailing Address - Phone:252-202-1848
Mailing Address - Fax:
Practice Address - Street 1:1010 FRISCOVILLE AVE
Practice Address - Street 2:
Practice Address - City:ARABI
Practice Address - State:LA
Practice Address - Zip Code:70032-1210
Practice Address - Country:US
Practice Address - Phone:252-202-1848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA952101YA0400X
LA3419101YP2500X
NC8762101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty