Provider Demographics
NPI:1386421832
Name:INTEGRATED SELF COUNSELING & SUPERVISION, PLLC
Entity type:Organization
Organization Name:INTEGRATED SELF COUNSELING & SUPERVISION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-797-1110
Mailing Address - Street 1:1724 TRILLIUM LN
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-9096
Mailing Address - Country:US
Mailing Address - Phone:540-797-1110
Mailing Address - Fax:
Practice Address - Street 1:1724 TRILLIUM LN
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-9096
Practice Address - Country:US
Practice Address - Phone:540-797-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health