Healthcare Provider Details

I. General information

NPI: 1952464927
Provider Name (Legal Business Name): GEORGE ALLEN HEINEN III CPSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ENTIRE STATE
COLUMBIA SC
29202
US

IV. Provider business mailing address

1800 COLONIAL DRIVE COTTAGE A
COLUMBIA SC
29202
US

V. Phone/Fax

Practice location:
  • Phone: 803-898-2025
  • Fax: 803-898-2194
Mailing address:
  • Phone:
  • 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: