INTEGRATING BODY, MIND AND LIFE, LLC (NPI# 1750559217) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750559217 |
| Entity Type | Organization |
| Organization Name | INTEGRATING BODY, MIND AND LIFE, LLC |
| Other Organization Name | IBML. LLC. |
| Practice Address |
2365 Wall St Se Suite 200-05 Conyers GA 30013-2197 |
| Mailing Address |
1 W Court Sq Suite 750 Decatur GA 30030-2538 |
| Practice Telephone | 8662983447 |
| Practice Fax Number | 8662615260 |
| Mailing Telephone | 8662983447 |
| Mailing Fax Number | 8662615260 |
| Enumeration Date | 2008-02-18 |
| Last Update Date | 2014-02-14 |
| Authorized Official Name | MS. MIREILLE ETIENNE (PARTNER/THERAPIST) |
| Authorized Official Telephone | 8662983447 |
| Authorized Official Credential | LPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
LPC004290 | GA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | CAQH | 11824149 | 01 |
| GA | 476557646A | 05 |
| Other Name | Type Code |
|---|---|
| IBML. LLC. | Other Name - Individual/Organization |
| Street Address |
2365 WALL ST SE SUITE 200-05 |
| City | CONYERS |
| State | GA |
| Zip Code | 30013-2197 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558425348 | Kenneth Frank Boscher | Chiropractor | 2365 Wall St Se, Suite 100, Conyers, GA 30013-2197 | 2006-12-19 |
| 1184974651 | Bruce Costello | Chiropractor | 2365 Wall St Se, Suite 100, Conyers, GA 30013-2197 | 2012-09-12 |
| 1700157831 | Vincent Veneziano | Chiropractor | 2365 Wall St Se, Suite 100, Conyers, GA 30013-2197 | 2012-01-20 |
| 1588999262 | Analia Home Health Care Services, LLC. | Home Health | 2365 Wall St Se, Suite 230, Conyers, GA 30013 | 2009-10-13 |
| 1255495933 | Julie Ann Frey | Massage Therapist | 2365 Wall St Se, Suite 100, Conyers, GA 30013-2197 | 2006-12-20 |
| 1164586962 | Rebekah Currin Boscher | Massage Therapist | 2365 Wall St Se, Suite 100, Conyers, GA 30013-2197 | 2006-12-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144842295 | Fit Therapy, LLC | Physical Therapist | 2008 Eastview Parkway, Suite 150, Conyers, GA 30013 | 2020-05-12 |
| 1144854753 | Atl Optical LLC | Optometrist | 1285 Ga 138, Conyers, GA 30013 | 2020-02-24 |
| 1386201820 | Achundris P Taylor | Social Worker | Harvest Grove Lane, Conyers, GA 30013 | 2019-05-21 |
| 1588153381 | Curbside Medical Transporters | Ambulance | 2404 Brynlyn Woods Dr Ne, Conyers, GA 30013 | 2018-05-07 |
| 1184124877 | Nursing Companion, LLC | Homemaker | 1064 Duke Dr, Conyers, GA 30013 | 2018-02-19 |
| 1588163638 | Atlanta Plus Urgent Care | Clinic/Center | 2121 Salem Rd. Se, Conyers, GA 30013 | 2018-02-05 |
| 1043735244 | Niki Tanyell Davis | Licensed Practical Nurse | 1403 Windy Hill Court, Conyers, GA 30013 | 2017-08-08 |
| 1063941490 | Comprehensive Health and Rehab LLC | Clinic/Center | 2500 Riverton Drive, Conyers, GA 30013 | 2017-06-08 |
| 1306373188 | Graceol Corporation | Family Medicine | 1035 Honey Creek Rd, Conyers, GA 30013 | 2017-05-11 |
| 1881149268 | Jsa Dental Associates Conyers PC | Dentist | 1151 Nor Tec Dr, Suite B, Conyers, GA 30013 | 2016-08-16 |
| Find all providers in zip 30013 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992321665 | Dream 4 You Coaching and Counseling Services | Counselor | 1540 Highway 138 Se Ste 2k, Conyers, GA 30013-1297 | 2020-06-18 |
| 1588286827 | Christopher James Mcclendon | Counselor | 2514 Lennox Rd Se, Conyers, GA 30094-2028 | 2020-05-09 |
| 1962038240 | Tricia Daniels | Counselor | 1175 Green Street, Se, Conyers, GA 30012-3001 | 2020-03-18 |
| 1043855836 | Maurvet Minto | Counselor | 1175 Green St, Conyers, Conyers, GA 30012 | 2019-11-15 |
| 1477044311 | Camille Antoinett Colson | Counselor | 2890 Georgia Highway 212 Sw Ste A-319, Conyers, GA 30094-3363 | 2018-05-27 |
| 1811493497 | Tiffany Jones | Counselor | 922 Court St Ne Ofc 103, Conyers, GA 30012-4540 | 2018-04-03 |
| 1841791944 | Vipp Counseling Services, LLC | Counselor | 903 Commercial St Ne Ste 203, Conyers, GA 30012-4553 | 2018-02-23 |
| 1619476330 | Keinetha Camille Powers | Counselor | 1396 Travers Creek Trl, Conyers, GA 30012-3584 | 2018-02-08 |
| 1831648468 | Teresa Anderson | Counselor | 1414 Steam Engine Way Ne, Conyers, GA 30013-1594 | 2016-09-23 |
| 1497108328 | Tamika Hibbert | Counselor | 1825 Regents Way, Conyers, GA 30094-3390 | 2016-07-15 |
| Find all providers in CONYERS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.