Provider Demographics
NPI:1063878197
Name:INTEGRATED BEHAVIORAL HEALTH SOLUTIONS PLLC
Entity type:Organization
Organization Name:INTEGRATED BEHAVIORAL HEALTH SOLUTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:336-681-2773
Mailing Address - Street 1:610 SUMMIT AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-7742
Mailing Address - Country:US
Mailing Address - Phone:336-355-1120
Mailing Address - Fax:844-273-1785
Practice Address - Street 1:610 SUMMIT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-7742
Practice Address - Country:US
Practice Address - Phone:336-355-1120
Practice Address - Fax:844-273-1785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0080251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1992058531Medicaid