Healthcare Provider Details

I. General information

NPI: 1629983804
Provider Name (Legal Business Name): MRS. HALLE POTEET HEINER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 N 6TH AVE
CHATSWORTH GA
30705-2852
US

IV. Provider business mailing address

434 BLUE WATER WAY
DALTON GA
30721-7017
US

V. Phone/Fax

Practice location:
  • Phone: 706-383-7290
  • Fax:
Mailing address:
  • Phone: 423-364-7990
  • 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:
Title or Position:
Credential:
Phone: