Organization Name: | INNOVATIVE THERAPY AND CONSULTING, INC |
NPI Number: | 1083812481 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LISA DRIVER (INCORPORATOR) |
Mailing Address: | 833 Wake Forest Business Park Suite G Wake Forest |
State: | NC US |
Postal Code: | 275877184 |
Phone Number: | 9195541231 |
Fax Number: | 9195542406 |
NPI Enumeration Date: | 07/06/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 5457 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |