Provider Demographics
NPI:1366911919
Name:INTEGRATIVE THERAPEUTIC COUNSELING SERVICES
Entity type:Organization
Organization Name:INTEGRATIVE THERAPEUTIC COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEENA
Authorized Official - Middle Name:ILEAN
Authorized Official - Last Name:HASTY
Authorized Official - Suffix:
Authorized Official - Credentials:LCASA-23287
Authorized Official - Phone:540-320-2859
Mailing Address - Street 1:607 PINE TREE ES DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-0517
Mailing Address - Country:US
Mailing Address - Phone:540-320-2859
Mailing Address - Fax:
Practice Address - Street 1:1101 TYVOLA RD STE 218
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3515
Practice Address - Country:US
Practice Address - Phone:540-320-2859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1992985972Medicaid