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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