Provider Demographics
NPI:1831764968
Name:INTEGRATIVE VIRTUAL MENTAL HEALTH
Entity type:Organization
Organization Name:INTEGRATIVE VIRTUAL MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:TREMBLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-339-7667
Mailing Address - Street 1:90 BELLVIEW RDG
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-1556
Mailing Address - Country:US
Mailing Address - Phone:678-559-9510
Mailing Address - Fax:
Practice Address - Street 1:285 W WIEUCA RD NE STE 5441
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3321
Practice Address - Country:US
Practice Address - Phone:678-559-9510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty