Healthcare Provider Details

I. General information

NPI: 1750952180
Provider Name (Legal Business Name): HEATHER MICHELE HALL CANEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 THOMASTON ST
ZEBULON GA
30295-3387
US

IV. Provider business mailing address

1170 HANNAHS MILL RD
THOMASTON GA
30286-2828
US

V. Phone/Fax

Practice location:
  • Phone: 404-960-1282
  • Fax:
Mailing address:
  • Phone: 706-975-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC010258
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: