Organization
INTEGRATIVE MEDICAL BEHAVIORAL HEALTHCARE, LLC
Active
Organization
INTEGRATIVE MEDICAL BEHAVIORAL HEALTHCARE, LLC
Active
Other names
Integrative Behavioral Heath, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARCELLA E FULTON LCSW (CEO)
(404) 643-9889
Entity
Organization
Contact information
Practice address
1842 INDEPENDENCE SQ STE D, DUNWOODY, GA 30338-5168
(404) 643-9889
(404) 393-8389
Mailing address
1842 INDEPENDENCE SQ STE D, DUNWOODY, GA 30338-5168
(404) 643-9889
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW002643
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003176378A
—
GA
01
—
1568645802
INDIVIDUAL NPI
—
Enumeration date
09/30/2016
Last updated
09/07/2018
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