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General NPI Number Information
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NPI Number | 1053498683
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Entity Type | Organization
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Legal Business Name | HEALING HEARTS THERAPEUTIC SERVICES, INC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/20/2012
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Provider Practice Location Address
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Address Line | 824 GUM BRANCH RD STE E
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City | JACKSONVILLE
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State | NC
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Zip | 28540-6269
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Country | US
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Telephone | 910-347-1694
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Fax | 910-347-3691
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Provider Business Mailing Address
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Address Line | 824 GUM BRANCH RD STE E
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City | JACKSONVILLE
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State | NC
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Zip | 28540-6269
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Country | US
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Telephone | 910-347-1694
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Fax | 910-347-3691
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Authorized Official
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Title or Position | CEO CLINICAL DIRECTOR
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Name | MRS. DEMETRIOUS SHEPARD
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Credential | LPC
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Telephone | 910-347-1694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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