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General NPI Number Information
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NPI Number | 1063937845
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Entity Type | Organization
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Legal Business Name | HEARTLAND COMMUNITY CHURCH, INC.
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 203 AVE A NW SUITE 300
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4540
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Country | US
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Telephone | 863-299-7787
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Fax | 863-299-7757
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Provider Business Mailing Address
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Address Line | 203 AVE A NW SUITE 300
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4540
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Country | US
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Telephone | 863-299-7787
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Fax | 863-299-7757
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ROBERT KIRK ALLISON JR.
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Credential | PSY.D.
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Telephone | 863-299-7787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY8924
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License Number State | FL
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