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General NPI Number Information
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NPI Number | 1811108053
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Entity Type | Organization
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Legal Business Name | S. CLARK HEINDEL, PH.D.
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Dates
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Enumeration Date | 05/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 136 W MCINTOSH ST STE B
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-3463
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Country | US
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Telephone | 478-456-5050
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Fax |
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Provider Business Mailing Address
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Address Line | 136 W MCINTOSH ST STE B
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-3463
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Country | US
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Telephone | 478-456-5050
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. S. CLARK HEINDEL
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Credential | PH.D.
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Telephone | 478-456-5050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 002415
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License Number State | GA
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