Provider Demographics
NPI:1750999876
Name:INTEGRAL MENTAL HEALTHCARE PLLC
Entity type:Organization
Organization Name:INTEGRAL MENTAL HEALTHCARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PA-C
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:910-644-6031
Mailing Address - Street 1:3505 BRACEBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-8999
Mailing Address - Country:US
Mailing Address - Phone:910-644-6031
Mailing Address - Fax:207-419-6495
Practice Address - Street 1:3505 BRACEBRIDGE CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-8999
Practice Address - Country:US
Practice Address - Phone:910-644-6031
Practice Address - Fax:207-419-6495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty