Provider Demographics
NPI:1487265120
Name:CAROLINA INTEGRATIVE THERAPY PLLC
Entity type:Organization
Organization Name:CAROLINA INTEGRATIVE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HINTERBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LCMHCA
Authorized Official - Phone:704-206-9810
Mailing Address - Street 1:18151 W CATAWBA AVE
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5641
Mailing Address - Country:US
Mailing Address - Phone:980-226-4165
Mailing Address - Fax:
Practice Address - Street 1:18151 W CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5641
Practice Address - Country:US
Practice Address - Phone:980-226-4165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty