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General NPI Number Information
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NPI Number | 1326496902
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Entity Type | Organization
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Legal Business Name | WHOLEHEARTED HEALING COUNSELING LLC
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 271B S CULVER ST STE H
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4805
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Country | US
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Telephone | 678-824-5899
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Fax |
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Provider Business Mailing Address
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Address Line | 271B S CULVER ST STE H
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4805
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Country | US
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Telephone | 719-290-0525
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE CHACIN
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Credential | LPC
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Telephone | 678-824-5899
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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 | 008888
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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