Healthcare Provider Details

I. General information

NPI: 1811819998
Provider Name (Legal Business Name): HEALING AND HEALTHY COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2967 CLARKSTON RD
AUGUSTA GA
30909-9221
US

IV. Provider business mailing address

2967 CLARKSTON RD
AUGUSTA GA
30909-9221
US

V. Phone/Fax

Practice location:
  • Phone: 470-645-1541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA SHINE
Title or Position: OWNER
Credential: EDD
Phone: 470-645-1541