Healthcare Provider Details

I. General information

NPI: 1407264997
Provider Name (Legal Business Name): ERIKA HEINZLE, MS, LPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HUNTINGTON RD SUITE 105
ATHENS GA
30606-7204
US

IV. Provider business mailing address

503 EDGEWOOD DR
ATHENS GA
30606-6534
US

V. Phone/Fax

Practice location:
  • Phone: 706-395-5266
  • Fax: 855-700-4579
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC007119
License Number StateGA

VIII. Authorized Official

Name: ERIKA NICHOLE HEINZLE
Title or Position: OWNER
Credential: MS, LPC
Phone: 706-395-5266