Integrated Wellness Counseling Services, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

LPC004683 Issued in GA

Legal business name

INTEGRATED WELLNESS COUNSELING SERVICES, LLC

Practice address

195 W Pike St
Suite 203
Lawrenceville, GA 30046-4966

Phone

(678) 318-1994

Fax

(678) 377-6080

NPI assigned

May 21, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Devona M Stalnaker, LPC

Title

Owner

Phone

(678) 318-1994

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Devona M. Stalnaker Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Devona M. Stalnaker-Shofner, LPC

  • Professional Counselor
  • Lawrenceville, GA
  • NPI 1144395252
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337558400000",
    "number": "1053671321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1359",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300461359",
            "telephone_number": "678-318-1994",
            "fax_number": "678-377-6080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 W PIKE ST",
            "address_2": "SUITE 203",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464966",
            "telephone_number": "678-318-1994",
            "fax_number": "678-377-6080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED WELLNESS COUNSELING SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-21",
        "last_updated": "2012-05-21",
        "status": "A",
        "authorized_official_last_name": "STALNAKER",
        "authorized_official_first_name": "DEVONA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-318-1994",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "LPC004683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12183939",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Devona M. Stalnaker",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.