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General NPI Number Information
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NPI Number | 1710554654
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Entity Type | Organization
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Legal Business Name | RESTORING HEARTS OF GEORGIA COUNSELING
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Dates
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Enumeration Date | 06/09/2021
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Last Update Date | 03/19/2026
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Provider Practice Location Address
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Address Line | 150 S PERRY ST STE 202
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4857
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Country | US
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Telephone | 678-200-6644
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Fax | 888-876-6566
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Provider Business Mailing Address
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Address Line | 1950 FAIRWAY CLOSE TER
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-6027
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Country | US
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Telephone | 678-200-6644
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Fax | 888-876-6566
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TRAKIDA MALDONADO
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Credential | LPC
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Telephone | 678-200-6644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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