Provider Demographics
NPI:1699381269
Name:INTEGRATIVE PSYCHIATRIC CARE PLLC
Entity type:Organization
Organization Name:INTEGRATIVE PSYCHIATRIC CARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-676-4060
Mailing Address - Street 1:2800 SAINT LEO ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3382
Mailing Address - Country:US
Mailing Address - Phone:336-676-4060
Mailing Address - Fax:336-676-5017
Practice Address - Street 1:2800 SAINT LEO ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3382
Practice Address - Country:US
Practice Address - Phone:336-676-4060
Practice Address - Fax:336-676-5017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-19
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty