Provider Demographics
NPI:1831410109
Name:INTEGRATIVE PSYCHOTHERAPY
Entity type:Organization
Organization Name:INTEGRATIVE PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:DAVISON
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, RN
Authorized Official - Phone:804-754-5814
Mailing Address - Street 1:3520 MAYLAND CT
Mailing Address - Street 2:B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1421
Mailing Address - Country:US
Mailing Address - Phone:804-754-5814
Mailing Address - Fax:
Practice Address - Street 1:3520 MAYLAND CT
Practice Address - Street 2:B
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1421
Practice Address - Country:US
Practice Address - Phone:804-754-5814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904007270261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1710217526OtherTYPE 1 NPI