Healthcare Provider Details

I. General information

NPI: 1700797453
Provider Name (Legal Business Name): AILEE HEARN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CENTRAL AVE STE D1
AUGUSTA GA
30904-6709
US

IV. Provider business mailing address

1011 COOPER PLACE DR
NORTH AUGUSTA SC
29860-8179
US

V. Phone/Fax

Practice location:
  • Phone: 706-843-6241
  • Fax:
Mailing address:
  • Phone: 505-330-1097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC011399
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: