| Integrative Mind Body Therapy, Llc | |
|
2511 Stadium Dr Charleston SC 29406-6606 | |
| (816) 752-6631 | |
| (844) 919-1630 |
| Full Name | Integrative Mind Body Therapy, Llc |
|---|---|
| Speciality | Counselor |
| Location | 2511 Stadium Dr, Charleston, South Carolina |
| Authorized Official Name and Position | Lisa Fracica (OWNER AND SOLE MEMBER) |
| Authorized Official Contact | 8167526631 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrative Mind Body Therapy, Llc 2511 Stadium Dr Charleston SC 29406-6606 Ph: (816) 752-6631 | Integrative Mind Body Therapy, Llc 2511 Stadium Dr Charleston SC 29406-6606 Ph: (816) 752-6631 |
| NPI Number | 1407594153 |
|---|---|
| Provider Enumeration Date | 05/23/2022 |
| Last Update Date | 11/01/2023 |
| Certification Date | 11/01/2023 |
| Medicare PECOS PAC ID | 5799121463 |
|---|---|
| Medicare Enrollment ID | O20240316000104 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407594153 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Lisa Fracica |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1245852946 PECOS PAC ID: 6608212378 Enrollment ID: I20240316000132 |
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