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General NPI Number Information
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NPI Number | 1780452953
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Entity Type | Organization
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Legal Business Name | COUNSELING HEARTS, PC
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Dates
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Enumeration Date | 12/18/2023
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 226 ALCOVY ST STE A3
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City | MONROE
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State | GA
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Zip | 30655-2184
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Country | US
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Telephone | 678-276-9894
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 196
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City | MONROE
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State | GA
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Zip | 30655-1320
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Country | US
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Telephone | 678-276-9894
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICE LAFAYE BENNETT
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Credential |
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Telephone | 678-276-9894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health 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 | 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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