Healthcare Provider Details

I. General information

NPI: 1518684703
Provider Name (Legal Business Name): HEALING HEARTS THERAPY SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 VIRGINIA AVE N STE 1
TIFTON GA
31794-4268
US

IV. Provider business mailing address

601 VIRGINIA AVE N STE 1
TIFTON GA
31794-4268
US

V. Phone/Fax

Practice location:
  • Phone: 229-396-5507
  • Fax:
Mailing address:
  • Phone: 229-396-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ERIN ROBISON
Title or Position: OWNER
Credential: LMFT
Phone: 229-396-5507