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General NPI Number Information
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NPI Number | 1336508605
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Entity Type | Organization
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Legal Business Name | HEALING HEARTS COUNSELING CENTER LLC
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Dates
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Enumeration Date | 02/16/2016
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Last Update Date | 02/16/2016
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Provider Practice Location Address
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Address Line | 2366 OLD LOWER RIVER RD
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-3022
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Country | US
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Telephone | 678-895-5681
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Fax | 877-575-9128
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Provider Business Mailing Address
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Address Line | 8310 OFFICE PARK DR SUITE 1A
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-6935
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Country | US
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Telephone | 678-895-5681
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Fax | 877-575-9128
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Authorized Official
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Title or Position | FOUNDER AND THERAPIST
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Name | HEATHER LAVINIA CONYERS
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Credential | LPC, NCC
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Telephone | 678-895-5681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC007613
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License Number State | GA
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