| Integrative Behavioral Heath, Llc | |
|
1842 Independence Sq Ste D Dunwoody GA 30338-5168 | |
| (404) 643-9889 | |
| (404) 393-8389 |
| Full Name | Integrative Behavioral Heath, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1842 Independence Sq Ste D, Dunwoody, Georgia |
| Authorized Official Name and Position | Marcella E Fulton (CEO) |
| Authorized Official Contact | 4046439889 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrative Behavioral Heath, Llc 1842 Independence Sq Ste D Dunwoody GA 30338-5168 Ph: (404) 643-9889 | Integrative Behavioral Heath, Llc 1842 Independence Sq Ste D Dunwoody GA 30338-5168 Ph: (404) 643-9889 |
| NPI Number | 1316496425 |
|---|---|
| Provider Enumeration Date | 09/30/2016 |
| Last Update Date | 09/07/2018 |
| Medicare PECOS PAC ID | 0143506436 |
|---|---|
| Medicare Enrollment ID | O20170801001434 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316496425 | NPI | - | NPPES |
| 1568645802 | Other | INDIVIDUAL NPI | |
| 003176378A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | CSW002643 (Georgia) | Primary |
| Provider Name | Marcella E Fulton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568645802 PECOS PAC ID: 9436231248 Enrollment ID: I20080201000339 |
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