Healthcare Provider Details

I. General information

NPI: 1780452953
Provider Name (Legal Business Name): COUNSELING HEARTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 ALCOVY ST STE A3
MONROE GA
30655-2184
US

IV. Provider business mailing address

PO BOX 196
MONROE GA
30655-1320
US

V. Phone/Fax

Practice location:
  • Phone: 678-276-9894
  • Fax:
Mailing address:
  • Phone: 678-276-9894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. PATRICE LAFAYE BENNETT
Title or Position: OWNER
Credential:
Phone: 678-276-9894